{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T07:01:18Z","timestamp":1790319678433,"version":"4.1.0"},"reference-count":15,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n \n Neurenteric cysts are rare congenital lesions that usually follow an indolent course. In cystic lesions, a fluid-fluid level generally indicates hemorrhage; in neurenteric cysts, it is seldom reported and poorly understood. Prior explanations rested largely on imaging and intraoperative inference. We report a cervicomedullary junction neurenteric cyst that enlarged rapidly after indolent growth, with a\n de novo<\/jats:italic>\n fluid-fluid level in the absence of hemorrhage, and propose a histopathologically supported mechanism.\n <\/jats:p>\n <\/jats:sec>\n \n Case Description:<\/jats:title>\n \n A 52-year-old man presented with posterior neck pain and dizziness. Magnetic resonance imaging demonstrated a 22-mm cystic lesion. Imaging 17 years earlier showed a 14-mm lesion. Over the next month, the cyst enlarged to 26 mm, developing a\n de novo<\/jats:italic>\n fluid-fluid level and perilesional edema. Although suspected, hemorrhage was not confirmed at surgery or on histopathology; the cyst contained viscous proteinaceous fluid. The resected cyst wall showed foam cell clusters, interpreted as indirect evidence of prior wall disruption. Complete resection was achieved without neurological deterioration or recurrence at 8 months.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n A fluid-fluid level in a neurenteric cyst does not necessarily indicate hemorrhage. It may instead reflect a rise in intracystic pressure from chronic mucin secretion that progressively compromises the cyst wall, allowing osmotic influx of cerebrospinal fluid that drives rapid enlargement and dilutes the upper layer. To the best of our knowledge, this is the first report in which foam cell clusters provide histological support for such a non-hemorrhagic mechanism in a neurenteric cyst. Interval growth or perilesional edema may precede deterioration and should prompt consideration of timely intervention.<\/jats:p>\n <\/jats:sec>","DOI":"10.25259\/sni_820_2026","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:50:30Z","timestamp":1790319030000},"page":"539","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rapid enlargement of a cervicomedullary junction neurenteric cyst with\n de novo<\/i>\n fluid-fluid level formation"],"prefix":"10.25259","volume":"17","author":[{"given":"Masaomi","family":"Takeuchi","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takeshi","family":"Hiu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Matsuoka","sequence":"additional","affiliation":[{"name":"Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minoru","family":"Morikawa","sequence":"additional","affiliation":[{"name":"Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiro","family":"Baba","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Matsuo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10894","published-online":{"date-parts":[[2026,9,25]]},"reference":[{"key":"10.25259\/SNI_820_2026\/ref-1","doi-asserted-by":"crossref","first-page":"2649","DOI":"10.1016\/j.radcr.2020.10.017","article-title":"Intracranial neurenteric cyst: A case report and differential diagnosis of intracranial cystic lesions","volume":"15","author":"Anderson","year":"2020","journal-title":"Radiol Case Rep"},{"key":"10.25259\/SNI_820_2026\/ref-2","first-page":"735","article-title":"Neuroimaging features of neurenteric cysts: Analysis of nine cases and review of the literature","volume":"14","author":"Brooks","year":"1993","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_820_2026\/ref-3","doi-asserted-by":"crossref","first-page":"42","DOI":"10.14791\/btrt.2017.5.1.42","article-title":"Fourth ventricle neurenteric cyst mimicking hemangioblastoma","volume":"5","author":"Choe","year":"2017","journal-title":"Brain Tumor Res Treat"},{"key":"10.25259\/SNI_820_2026\/ref-4","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.jocn.2011.10.005","article-title":"Intracranial neuroenteric cysts: A concise review including an illustrative patient","volume":"19","author":"Gauden","year":"2012","journal-title":"J Clin Neurosci"},{"key":"10.25259\/SNI_820_2026\/ref-5","first-page":"e8714","article-title":"Neurenteric cyst: Case report and operative video","volume":"12","author":"Gopakumar","year":"2020","journal-title":"Cureus"},{"key":"10.25259\/SNI_820_2026\/ref-6","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/00004728-199901000-00008","article-title":"Rathke cleft cyst: MR and biomedical analysis of cyst content","volume":"23","author":"Hayashi","year":"1999","journal-title":"J Comput Assist Tomogr"},{"key":"10.25259\/SNI_820_2026\/ref-7","doi-asserted-by":"crossref","first-page":"542","DOI":"10.3171\/2012.1.PEDS11469","article-title":"Intramedullary spinal neurenteric cyst with fluid-fluid level","volume":"9","author":"Jhawar","year":"2012","journal-title":"J Neurosurg Pediatr"},{"key":"10.25259\/SNI_820_2026\/ref-8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1227\/01.NEU.0000192160.79897.25","article-title":"Spinal neurenteric cysts in the magnetic resonance imaging era","volume":"58","author":"Menezes","year":"2006","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_820_2026\/ref-9","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1055\/s-0031-1284206","article-title":"Posterior fossa neurenteric cysts can expand rapidly: Case report","volume":"1","author":"Priamo","year":"2011","journal-title":"Skull Base Rep"},{"key":"10.25259\/SNI_820_2026\/ref-10","first-page":"496","article-title":"Neurenteric cyst with alteration of signal intensity on follow-up MR images","volume":"22","author":"Shakudo","year":"2001","journal-title":"AJNR Am J Neuroradiol"},{"key":"10.25259\/SNI_820_2026\/ref-11","doi-asserted-by":"crossref","first-page":"CASE24180","DOI":"10.3171\/CASE24180","article-title":"Enlarging neurenteric cyst at the craniocervical junction with a fluid-fluid level on magnetic resonance imaging: Illustrative case","volume":"8","author":"Takahashi","year":"2024","journal-title":"J Neurosurg Case Lessons"},{"key":"10.25259\/SNI_820_2026\/ref-12","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3109\/02688697.2014.993594","article-title":"Unusual imaging finding of a \u201cfluid-fluid\u201d level in a neurenteric cyst at anterior margin of the cervico-medullary junction","volume":"29","author":"Tripathi","year":"2015","journal-title":"Br J Neurosurg"},{"key":"10.25259\/SNI_820_2026\/ref-13","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1016\/S0090-3019(01)00590-0","article-title":"Surgical management of medullary hemangioblastoma. Report of 47 cases","volume":"56","author":"Wang","year":"2001","journal-title":"Surg Neurol"},{"key":"10.25259\/SNI_820_2026\/ref-14","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1227\/NEU.0b013e3181fc5ee0","article-title":"Diagnosis and management of adult intracranial neurenteric cysts","volume":"68","author":"Wang","year":"2011","journal-title":"Neurosurgery"},{"key":"10.25259\/SNI_820_2026\/ref-15","doi-asserted-by":"crossref","first-page":"3123","DOI":"10.3892\/etm.2017.4299","article-title":"Fluid-fluid level on magnetic resonance images may predict the occurrence of pituitary adenomas in cystic sellar-suprasellar masses","volume":"13","author":"Xiao","year":"2017","journal-title":"Exp Ther Med"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/rapid-enlargement-of-a-cervicomedullary-junction-neurenteric-cyst-with-de-novo-fluid-fluid-level-formation\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/rapid-enlargement-of-a-cervicomedullary-junction-neurenteric-cyst-with-de-novo-fluid-fluid-level-formation\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:50:32Z","timestamp":1790319032000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/rapid-enlargement-of-a-cervicomedullary-junction-neurenteric-cyst-with-de-novo-fluid-fluid-level-formation\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,25]]},"references-count":15,"alternative-id":["10.25259\/SNI_820_2026"],"URL":"https:\/\/doi.org\/10.25259\/sni_820_2026","relation":{},"ISSN":["2152-7806","2229-5097"],"issn-type":[{"value":"2152-7806","type":"electronic"},{"value":"2229-5097","type":"print"}],"subject":[],"published":{"date-parts":[[2026,9,25]]},"article-number":"539"}}