Extended retrosigmoid approach to ventro-lateral foramen magnum neuroenteric cyst: 2D- dimensional video

Abstract

Neuroenteric cysts (NC) are rare benign congenital neoplasms arising from displaced elements of the alimentary canal. They are commonly located within the spine. Although they can occur in any region of the central nervous system, foramen magnum (FM) NC are extremely rare. Because of the close relationship of the FM and critical neurovascular structures, total resection may be difficult. Extended retrosigmoid approach is a simple and safe surgical approach that increases the surgical exposure and corridor, decreasing the necessity of cerebellar retraction or the use of more radical approaches, such as transpetrosal approaches or far-lateral approach, which are associate with significant morbidity and lengthy. A previously healthy 41-year-old female came to our service complaining of intermittent mild occipital headache and bilateral paresthesia. On neurological examination she had no complaints on the physical examination. Preoperative magnetic resonance imaging (MRI) evaluation revealed a well-defined lesion, hyperintense on T1WI and hypointense on T2WI and FLAIR, no restriction was seen on DWI, and there was mild enhancement on contrastenhanced T1WI. Total resection of the cyst wall and cyst contents was achieved via extended retrosigmoid approach. She was discharged with no neurologic deficit. The latest follow-up MRI at 12 months post surgery showed no evidence of lesion recurrence. The patient gave informed consent for surgery and video recording (Video 1).

Keywords

• Extended retrosigmoid approach
• Foramen magnum
• Neuroenteric cyst