Our Summary

This research paper describes the case of a 7-month-old boy who had a rare type of cyst in his neck, called a neurenteric cyst. These cysts are formed before birth when two layers of cells in the embryo don’t separate properly. In this case, the cyst was causing the baby to have episodes of neck stiffness and irritability. Doctors removed the cyst, but it grew back and had to be removed again. After the surgeries, the boy developed other complications - a type of meningitis that wasn’t caused by bacteria, and a condition where the spinal cord is abnormally attached, causing it to be stretched. These required further treatments including a procedure to drain excess fluid from the brain and another one to free the tethered spinal cord. The paper suggests that the boy’s initial symptoms of pain might have been caused by the cyst filling up and emptying out, and emphasizes that a tethered spinal cord is a rare but possible complication of having a neurenteric cyst.

FAQs

  1. What is a neurenteric cyst and how does it form?
  2. What are the complications that might occur after the surgery for neurenteric cyst?
  3. What is detethering surgery and why was it necessary in this case?

Doctor’s Tip

One helpful tip a doctor might tell a patient about detethering surgery is to follow post-operative care instructions carefully, including any restrictions on movement or activities to ensure proper healing and prevent complications. It is also important to attend all follow-up appointments and communicate any new symptoms or concerns to your healthcare provider promptly.

Suitable For

Patients with neurenteric cysts, particularly those with symptoms such as intermittent neck stiffness and irritability, may be recommended for detethering surgery if they develop tethered cord syndrome. Additionally, patients who experience complications such as hydrocephalus or aseptic meningitis may also require detethering surgery as part of their treatment plan. Detethering surgery may be necessary to alleviate symptoms, prevent further complications, and improve overall quality of life for these patients.

Timeline

Before detethering surgery:

  1. Patient experiences intermittent neck stiffness and irritability
  2. Cyst is resected but recurs, requiring repeat surgery
  3. Postoperative complications include aseptic meningitis and hydrocephalus
  4. Ventriculoperitoneal shunt is placed to manage hydrocephalus

After detethering surgery:

  1. Patient undergoes detethering surgery to manage tethered cord
  2. Additional imaging work-up and monitoring is required
  3. Patient may experience improvement in symptoms related to tethered cord
  4. Follow-up care and monitoring is necessary to ensure optimal outcomes

What to Ask Your Doctor

  1. What is the specific reason for recommending detethering surgery in my case?
  2. What are the potential risks and complications associated with detethering surgery?
  3. How long is the recovery process expected to be after detethering surgery?
  4. Will I need any additional treatments or therapies following detethering surgery?
  5. What is the success rate of detethering surgery for patients with a similar condition to mine?
  6. Are there any specific precautions or lifestyle changes I should follow after detethering surgery?
  7. How often will I need follow-up appointments or imaging tests after detethering surgery?
  8. Are there any alternative treatment options to detethering surgery that I should consider?
  9. What is the long-term prognosis for individuals who undergo detethering surgery?
  10. Can you provide me with more information about the potential complications of tethered cord syndrome and how detethering surgery can help alleviate symptoms?

Reference

Authors: Esfahani DR, Burokas L, Brown HG, Hahn YS, Nikas D. Journal: Childs Nerv Syst. 2017 Sep;33(9):1603-1607. doi: 10.1007/s00381-017-3487-x. Epub 2017 Jun 22. PMID: 28643040