1. Extreme lateral approach in a case of acute-onset quadriplegia due to high cervical neurenteric cyst.
- Author
-
Abhishek A, Anushree A, Patir R, and Sehgal AD
- Subjects
- Acute Disease, Cervical Vertebrae surgery, Diagnosis, Differential, Fatal Outcome, Follow-Up Studies, Humans, Infant, Laminectomy, Magnetic Resonance Imaging, Male, Neural Tube Defects diagnosis, Neurologic Examination, Postoperative Complications diagnosis, Quadriplegia diagnosis, Respiratory Insufficiency etiology, Staphylococcal Infections diagnosis, Staphylococcal Infections surgery, Neural Tube Defects complications, Neural Tube Defects surgery, Quadriplegia etiology, Quadriplegia surgery, Staphylococcal Infections complications
- Abstract
Spinal neurenteric cysts are very rare intradural developmental lesions, predominantly localized anterior to the cervical cord and arising from misplaced endodermal cells in the 3rd week of embryonic life. An acute onset of symptoms can occur due to hemorrhage, but has not as yet been reported in relation to infection in the cyst. We report an 18-year-old male who presented with a rapid onset of respiratory distress and quadriplegia over a period of 6 h requiring intubation and ventilatory support. There was no respiratory effort with a dense sensory level from the neck. MRI of the cervical spine revealed an intradural extramedullary ventrally located cystic lesion at the C(2-3) level. There was no evidence of systemic infection elsewhere in the body. The lesion was radically excised using an extreme lateral approach as it provided excellent visualization of the cyst, thus permitting safe dissection without retraction of the cord. The cyst was tense and the contents turbid, thick, creamy and mucinous without any evidence of fresh or altered blood. Histopathological examination confirmed the cyst to be a neurenteric cyst. The cystic fluid, which was sent for culture, grew coagulase-negative Staphylococcus aureus. This is the first documented case of rapid neurological deterioration due to infection in a neurenteric cyst. In spite of an early effective surgical management, outcome was poor due to the rapid and profound neurological deficit., (Copyright (c) 2007 S. Karger AG, Basel.)
- Published
- 2007
- Full Text
- View/download PDF