Child with progressive limb weakness caused by a neuroenteric cyst in the cervical segment: A case report

Rationale: Neurenteric cyst is a rare congenital cystic lesion within the spinal canal that originates from the failure of the separation between the neural tube and the endoderm during the embryonic period. This disease is more commonly observed in the cervical and thoracic spinal cord. Pediatric cases are even rarer. The clinical manifestations are diverse. Early recognition and surgical intervention are crucial for the prognosis. Patient concerns: The male child was 3 years and 5 months old. He presented for medical attention due to “neck pain accompanied by limited mobility for 10 days” and was secondarily accompanied by weakness in the right upper limb and abnormal gait. The patient had a history of minor neck trauma history before the onset of the illness. Diagnoses: Magnetic resonance imaging shows a cystic lesion with low longitudinal relaxation time signal and high transverse relaxation time signal on the ventral side of the spinal canal at the cervical vertebra2–cervical vertebra 4 segments. There is no obvious enhancement, and neuroenteric cyst was suspected. Interventions: Subdural lesion resection and spinal canal plasty were performed under general anesthesia. During the operation, the cyst was located on the ventral side of the spinal cord, and the cyst wall was intact. The lesion was completely resected under the microscope. Outcomes: At the time of discharge, the muscle strength of the right upper limb had recovered to grade 3+ and that of the right lower limb to grade 4+. Neck pain was significantly relieved. Postoperative magnetic resonance imaging showed that the tumor was completely resected and the compression of the spinal cord was significantly relieved. The postoperative pathological diagnosis was consistent with a neuroenteric cyst. Lessons: This case suggests that although neuroenteric cysts are rare in children, their possibility should be considered in cases of neck pain accompanied by neurological dysfunction. Magnetic resonance imaging is the main diagnostic method, and complete surgical resection is currently the most effective treatment method. Intraoperative neuroelectrophysiological monitoring helps reduce the risk of neurological injury. The purpose and significance of this study lie in enhancing the understanding of neuroenteric cyst disease, improving the diagnostic rate, and reducing postoperative complications.