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Updated: Sep 4, 2025
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Intraoperative Ultrasound in Spinal Surgery
Published on: August 17, 2022
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Intradural cyst: intramedullary or extramedullary? Illustrative case
Timothy Kim1, Brendan Judy1, Timothy Witham1
1Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland.
Journal of Neurosurgery. Case Lessons
|July 20, 2022
Summary
Ventriculus terminalis (VT) cysts, though rare, can mimic extramedullary lesions on imaging. This intramedullary cyst was successfully treated with fenestration, improving patient outcomes.
Area of Science:
- Neurosurgery
- Spinal Imaging
- Cystic Lesions
Background:
- Intradural spinal cord cysts are uncommon and typically benign.
- Preoperative imaging can make differentiating intramedullary from extramedullary cysts challenging.
- A patient presented with severe back pain and imbalance due to a ventriculus terminalis cyst.
Observation:
- Preoperative imaging suggested an extramedullary cystic lesion.
- Intraoperative findings confirmed the ventriculus terminalis cyst was intramedullary.
Findings:
- The ventriculus terminalis (VT) is a rare cystic expansion of the conus medullaris.
- VT cysts can present with imaging characteristics that suggest an extramedullary location.
- The lesion was successfully treated via fenestration.
Implications:
- Accurate intraoperative localization is crucial for managing VT cysts.
- Fenestration is an effective treatment for symptomatic intramedullary VT cysts.
- Understanding VT cyst presentation aids in surgical planning and patient management.
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