Background

Choroid plexus cysts are benign neuroepithelial lesions that are typically encountered within the lateral ventricles of the brain and are often discovered incidentally during fetal ultrasonography. Their occurrence within the spinal cord is extraordinarily uncommon, with only a handful of cases previously described in the literature.

Because intramedullary spinal cysts share overlapping imaging characteristics, establishing a definitive diagnosis can be challenging. This report by Alassaf et al. describes a symptomatic thoracic spinal choroid plexus cyst presenting with progressive spinal cord compression.

The Case

A 55-year-old Syrian man with no significant past medical history presented with chronic dorsal pain and progressive lower-extremity weakness. Neurological examination demonstrated bilateral motor deficits and left-sided radicular pain, while sensory function and sphincter control remained intact.

Initial lumbar MRI was unrevealing, but contrast-enhanced thoracic MRI demonstrated a 1.43-cm intramedullary cystic lesion at the T5–T6 level producing spinal cord compression. The lesion displayed cerebrospinal fluid signal characteristics, appearing hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging.

Surgical Management

The patient underwent T5–T6 laminectomy followed by cyst marsupialization and fenestration. Complete excision was not feasible because the cyst was firmly adherent to surrounding spinal cord tissue. Histopathological examination performed by two independent pathologists confirmed the diagnosis of a choroid plexus cyst.

Postoperatively, the patient received intravenous methylprednisolone and participated in physiotherapy. No complications were encountered during hospitalization. Follow-up MRI demonstrated decompression of the spinal cord without recurrence. Radicular pain resolved, and motor strength improved modestly over the ensuing two months.

Why This Case Matters

The differential diagnosis of intramedullary cystic lesions commonly includes:

• Ependymal cysts
• Arachnoid cysts
• Neurenteric cysts
• Epidermoid and dermoid cysts
• Neoplastic lesions such as ependymoma or astrocytoma

Choroid plexus cysts are seldom considered because of their rarity in the spinal cord. However, MRI appearances frequently overlap among these entities, limiting radiographic specificity. Consequently, histopathological examination remains the gold standard for diagnosis.

This case also illustrates an important surgical principle: complete excision of intramedullary cysts may not always be possible or desirable. In symptomatic patients, decompression by fenestration or marsupialization can provide meaningful clinical benefit while minimizing the risk of neurological injury.

Key Lessons

• Intramedullary choroid plexus cysts are exceptionally rare.
• Progressive myelopathy and radicular pain may result from spinal cord compression.
• MRI is indispensable for lesion localization and surgical planning.
• Imaging alone cannot reliably distinguish among various spinal cysts.
• Histopathology is essential for definitive diagnosis.
• Surgical decompression can alleviate symptoms even when complete resection is impossible.
• Additional cases and multicenter registries are needed to better characterize these lesions.

Clinical Take-Home Message

Although choroid plexus cysts are classically intracranial lesions, they should be included among the rare causes of intramedullary spinal cysts. In patients with progressive thoracic myelopathy, MRI guides diagnosis and operative planning, but definitive identification ultimately depends on histopathological examination. Symptomatic lesions can be successfully managed with surgical decompression when complete excision is unsafe.

Reference:
Alassaf S, Khattab K, Karaja S, Batarseh SF, Assaf A, Outhman R, Abboud Z, Ali MS, AlChawwaf AZ. Choroid plexus cyst of the spinal cord presenting with signs of spinal cord compression in a 55-year-old male: a case report. Journal of Medical Case Reports. 2026;20:294. 

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