Spinal Intradural Cysts

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Neurenteric cysts

Epidermoid and dermoid cysts

Intraspinal neurenteric cysts form a spectrum that merges with intraspinal teratomas and intraspinal dermoids and epidermoids. More than 60% of the cases are diagnosed in the first 20 years of life; 44% are located totally or partially in the cervical spinal canal, 37% are located in the thoracic spinal canal, and 19% in the lumbosacral spinal canal. The neurological signs and symptoms of a slowly progressing mass are associated by congenital anomalies, such as thickened or pigmented skin, a cutaneous dimple or dermal sinus, or a tuft of hair may occur in the midline of the back

These account for 0.2 - 2% of primary spinal tumors in adults; in children, however, these cysts represent 3-13% of such spinal tumors, and within the first year of life the incidence is even higher, at 17%. At least 62% of dermoid cysts and 63% of epidermoid cysts occur at or below the thoracolumbar junction. Among intraspinal dermoids, 30% are wholly or partially intramedullary in location, and 28% of intraspinal epidermoids are wholly or partially intramedullary. With regard to associated defects, 25% of cases have posterior spina bifida, and 34% of dermoid cysts and 20% of epidermoid cysts occur in patients with a posterior dermal sinus tract. Eleven of 12 sinus tracts in

Arachnoid cysts

- Developmental

- Inflammatory

- Posttraumatic

Ependymal (neuroepithelial) cysts

Other intramedullary cysts of the conus medullaris

Spinal cysticercosis

Chronic spinal subdural hematomas the thoracic region terminated in intradural congenital tumor. Scoliosis may develop as the cyst enlarges in a child. CT and MRI have proved useful in the diagnostic work-up; there is a high signal on T1-weighted and T2-weighted images

These cysts consist of arachnoid, and are filled with CSF. The cysts are not associated with spinal dys-raphism or any other congenital anomalies. They typically occur in the thoracic area, posterior to the spinal cord. They are initially asymptomatic, but when they enlarge in size they can cause back pain, usually relieved when the patient lies down, radicular pain, and paraparesis. Occasionally, kyphoscoliosis will develop as the cyst grows. On MRI, a focal impression of the cord can be seen, with an intensity similar to that of CSF without enhancement

A thin wall consisting of connective tissue lined by a single layer of cells that resemble ependymal cells, similar to a neurenteric cyst. In contrast to the latter, however, the epithelium of the ependymal cells does not have a basement membrane or contain mucin. These cysts are located between C2 and L5, but nearly 45 % are at the thoracolumbar junction, and most have intramedullary extensions

A few intramedullary cysts occur within the conus, and have a thin, transparent wall cyst consisting of narrow bands of glial tissue lined by a layer of ependy-mal cells

The average incidence of intraspinal forms is about 5-6%. The parasites grow in the subarachnoid spinal space, forming multiple cysts, rather than within the spinal cord, where the cysts are usually solitary. Myelography, CT, and MRI are the key diagnostic modalities. The specific diagnosis can be suspected if there is known disease elsewhere, or if there is either eosino-philia in the CSF or a positive complement fixation test for cysticercosis

CSF: cerebrospinal fluid; CT: computed tomography; MRI: magnetic resonance imaging.

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