FIRST SLIDE, 1st BULLET

It arises during embryonic development when the notochord and primitive gut fail to separate properly.
As a result, remnants of endodermal and ectodermal tissue remain in close proximity, leading to the
formation of a cystic structure.

FIRST SLIDE, 3rd BULLET

Posterior fossa - a small space in the skull, found near the brainstem and cerebellum

Neuroaxis - is the axis of the central nervous system. It denotes the direction in which the central
nervous system lies.

FIRST SLIDE, 4TH BULLET

Clinically, neurenteric cysts may remain asymptomatic for a long time or present with symptoms
depending on their location, size, and compression of adjacent structures. Common symptoms may
include

1. Neurological Symptoms: Depending on the location of the cyst, individuals may experience
neurological symptoms such as weakness, numbness, tingling, or changes in sensation in the arms,
legs, or other parts of the body. These symptoms can occur due to compression or irritation of the
spinal cord or nerve roots.
2. Back Pain: Pain in the back or neck region may occur, especially if the cyst is located in the spinal
canal and causing compression of surrounding structures.
3. Headaches: Cysts located in the intracranial region (within the skull) may lead to headaches,
particularly if they are causing increased pressure within the brain or interfering with the flow of
cerebrospinal fluid.
4. Body Coordination Problems: Cysts that compress the spinal cord or cerebellum (part of the brain
responsible for coordination and balance) may result in difficulty walking, poor coordination, or
balance problems.
5. Bladder or Bowel Dysfunction: In some cases, neurenteric cysts located in the spinal canal may
compress the nerves that control bladder or bowel function, leading to urinary or fecal incontinence
(lack of voluntary control over urination or defecation), difficulty with urination or defecation, or
other bladder or bowel dysfunction.

SECOND SLIDE, 1ST BULLET

 A case report of neuroenteric cyst of spinal canal presenting with hemiparesis in a 12 years old
female child. The patient had no associated underlying spinal deformity. However, based on the
investigation on her magnetic resonance imaging (MRI), it revealed evidence of well-defined,
intradural extramedullary cystic lesions at C6 to D2 vertebral level, situated anterior and right to
the cord causing posterior and leftward displacement with marked cord compression at this
level. The child underwent posterior laminectomy and excision of cyst with complete recovery
and no residual deficit.
 Laminectomy is a type of surgery in which a surgeon removes part or all of the vertebral bone
(lamina). This helps ease pressure on the spinal cord or the nerve roots that may be caused by
injury, herniated disk, narrowing of the canal (spinal stenosis), or tumors.

SECOND SLIDE, 2nd BULLET

 A 36-year-old male presented with worsening left arm and leg paresthesias and issues with
bladder control. Initially, the patient felt tingling and numbness in the left posterior arm, medial
forearm, and left hand involving the third, fourth, and fifth digits. These symptoms eventually
progressed to the left leg and were accompanied by episodes of urinary incontinence and ataxia.

Ataxia means without coordination. People with ataxia lose muscle control in their arms and
legs. This may lead to a lack of balance, coordination, and trouble walking. Ataxia may affect the
fingers, hands, arms, legs, body, speech, and even eye movements.

On physical exam, the patient had weakness of the left-hand intrinsic muscles. The sensation
was diminished in the left C8. MRI cervical spine revealed a large anterior intradural,
extramedullary cystic spinal lesion at C6/C7 with compression of the spinal cord posteriorly.
There was also a lesion in his T2 and T1 which measures 1.6 x 2.7 x 3.5 cm in size.

Treatment of the cyst involved partial laminectomies at C5 and T1 and a C6-C7 laminectomy. This
was followed by fenestration and excision of the cyst and a C6-C7 laminoplasty

FOURTH SLIDE, 2ND BULLET

1. Observation: In cases where the neurenteric cyst is small, asymptomatic, and not causing any
complications, a conservative approach of close observation may be recommended. Regular monitoring
with imaging studies such as MRI or CT scans may be performed to assess the size and stability of the
cyst over time.

2. Surgical Resection: Surgical removal (resection) of the neurenteric cyst is often the preferred
treatment for symptomatic or large cysts, as well as those causing neurological deficits or other
complications. The goal of surgery is to completely excise the cyst while minimizing damage to
surrounding neural structures. Depending on the location and size of the cyst, surgical approaches may
include open microsurgical techniques or minimally invasive endoscopic procedures.

3. Cyst Fenestration: In some cases, particularly for cysts located in challenging or inaccessible areas,
such as deep within the brainstem, fenestration may be performed instead of complete resection.
Fenestration involves creating a small opening or window in the cyst wall to allow drainage of cystic fluid
and decompression of surrounding tissues.

FIFTH SLIDE

1. Formation of the Neurenteric Canal: As the embryo develops, the neurenteric canal forms. The
neurenteric canal serves as a passageway for nutrients and waste products during early development.
2. Closure of the Neurenteric Canal: Normally, the neurenteric canal undergoes closure during
embryonic development, separating the developing nervous system (ectoderm) from the primitive gut
(endoderm). This closure is essential for the proper development and differentiation of these germ
layers.

3. Abnormality during the closure: In cases of neurenteric cysts, there is an abnormal persistence of
communication between the endoderm and ectoderm germ layers due to failure of the neurenteric
canal to close properly. This persistent communication allows for the exchange of cells and tissues
between the developing nervous system and primitive gut.

4. Trapping of Tissues: Remnants of endodermal and ectodermal tissues can become trapped, leading to
the formation of a cystic structure known as a neurenteric cyst.

5. Cyst Development: Over time, the trapped tissues within the neurenteric cyst can proliferate
(reproduce rapidly, multiply) and expand, resulting in the growth of the cyst. Neurenteric cysts can vary
in size and location, depending on the extent of the abnormality and the surrounding embryonic
structures.