Spine tumors 6 – Cysts and Summary

Spine tumors 6 – Cysts and Summary

A few lesions within the spinal canal are predominantly cystic or nonenhancing. They are almost always intradural extramedullary. The three most common entities are arachnoid cysts, dermoid cysts, and neuroenteric cysts. A contrast enhanced myelogram can often give you a little bit more information about what the entity is by determining if it fills with contrast.

0:59 Case 1. Arachnoid cyst. Arachnoid cysts in the spine are somewhat uncommon but will have the same characteristics as CSF on all images. They may often be identified only by their deflection of the spinal cord and mass effect. Their main differential is arachnoid webs or adhesions which cause similar mass effect on the spinal cord. On myelography, they often fill with contrast but more slowly than the surrounding CSF.

3:37 Case 2. Dermoid. Dermal inclusion cysts, or dermoids, are complex lesions made out of tissue from more than one embryonal layer. Their characteristic feature is internal fat contents. Like intracranial dermoids, they can rupture and cause a chemical meningitis. Their appearance overlaps with lipomas but they are more likely to have complex features

5:02 Case 3. Neuroenteric cysts. Neuroenteric cysts are relatively simple cystic lesions which often occur ventral to the brainstem or spinal cord. They often are similar to but not exactly like CSF, and can be T1 hyperintense. They are indolent lesions but can cause mass effect. They do not fill on myelography.

6:57 Cyst summary. These are three of the most common cystic lesions. They are best differentiated by whether they communicate with the thecal sac (arachoid cysts), have complex or fatty features (dermoids), or are ventral to the cord and slightly differ from CSF (neuroenteric cysts).

7:36 Summary of spine tumors by location. Overall, when thinking about spine tumor, you should take a location-based approach. If you haven’t seen the introduction video yet, then definitely check it out. When divided by intramedullary, intradural extramedullary, and extradural, this can help you decide what type of lesion you are dealing with. Overall, always remember that the spine is an extension of the central nervous system, and consider imaging the brain because that may help you hone your differential diagnosis.

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[caiyu]

Both your excellent tutorial and other teacher excellent tutorials on neuroenteric cyst make me understand it better. These excellent lectures are complementary and benefit our learners. YouTube is a nice place that there are so many excellent teachers.

[debbieescobar]

At age 23 I had a very large ependymoma T10 to L5 (I am now 71). It was excised with subsequent scar tissue formation which eventually caused neuropathy in my legs and feet. Now I have great difficulty with balance, walking, basically everything we depend on from the waist down. I have never met another person who'd had a spinal ependymoma or a physician who'd seen a case other than mine. It has wreaked havoc in my life. Every health issue I have leads back to the outcome of that tumor.

[caiyu]

Thank you for upload an excellent tutorial. Keep on learning from your excellent tutorials.

[skeletopedia]

Wow Case 1 is hard to see on solely T2 sag. Blends in with CSF. Spine tumors are challenging. Thanks for the overview Doc

[CoffeeMuggger]

What do I do if my Dr. is ignoring my results from MRI. I’ve had complaints of lumbar pain for last 6 years and have like 3 mris and many X-rays.. all finding

L3-l4: “1.1 x 0.5 cm ovoid high T2 signal intensity lesion.”

L5-s1: “Adjacent to the bilateral facet joints, there is high T2 signal intensity lesion (5 mm on the right
and 8 mm on the left).” *this specific lesion was also documented 3 years later 2023”

2019 right hip X-ray: “1 cm ovoid sclerotic density with
lucent center” (was seen on prior X-ray including frog-leg two years prior)

Now there are many other issues but what are these freaking lesions? I know it’s a long shot but y’all sound like you know what you’re talking about.