Dorsal Intradural Extramedullary Bronchogenic Cysts: A Case Report and Comprehensive Literature Review

Intradural extramedullary bronchogenic cysts (IEBCs) are exceedingly rare congenital entities, composed of respiratory epithelial cells derived from the anomalous development of the embryonic foregut. Due to their exceptionally low morbidity, only limited cases are available. Consequently, the clinical features and optimal therapeutic approach remain poorly understood. We report a very unusual case of a 54-year-old Mexican male who initially presented with paraparesis seven years ago, leading to a significant gait disturbance. Conservative therapy was employed, with notable improvements seen after four months of treatment. No additional ambulation assistance was required over the following six years, reflecting a stable progression of the condition. However, the patient experienced a worsening recurrent paraparesis, along with episodic dorsal pain in the last year. Physical examination revealed a reduction in lower extremity strength, with preservation of sensory function. Magnetic resonance imaging (MRI) showed an intraspinal, intradural extramedullary lesion in the dorsal region, extending for at least 50% of the canal. Areas of hyperintensity on the T2 sequence, with a fusion of vertebral bodies at the T3-T4 levels, were observed. A posterior dorsal approach was performed with T2-T4 laminectomy, durotomy, and resection of the cystic lesion, draining the cyst and removing the capsule. Histopathology from the capsule reported a ciliated cyst morphologically characterized by bronchogenic features; immunohistochemistry revealed positivity for cytokeratin cocktail AE1/AE3. Follow-up MRI showed no residual lesion, without further complications. Surgical resection is the most effective treatment for intraspinal bronchogenic cysts, providing significant symptom relief. Complete removal is ideal, while partial resection may reduce complications in cases with severe adhesions; however, it increases the risk of recurrence. Due to the rarity of the disease, the number of cases is relatively limited. Future studies should strongly consider employing a larger sample size and extending the follow-up period to better understand the spectrum of the disease.