Pediatric Neurenteric Cysts of the Spine: A Case Report of Two Cases with Review of Literature.

Neurenteric cysts are rare, benign congenital lesions of endodermal origin that primarily affect the spinal cord. Their clinical and radiological presentations can vary significantly, especially in pediatric patients, complicating diagnosis and management. We report two pediatric cases of spinal neurenteric cysts and review the relevant literature. An 11-month-old infant presented with progressive lower limb weakness. Magnetic resonance imaging (MRI) revealed a nonenhancing intradural cystic lesion at the thoracic level. A 14-year-old female reported neck pain and upper limb paresthesia; cervical spine MRI showed a well-demarcated T2-hyperintense cystic lesion. Both patients underwent complete surgical excision. Histopathology confirmed neurenteric cysts, showing pseudostratified or columnar epithelium with interspersed goblet cells. Postoperative recovery was uneventful, with no recurrence at 6-month and 1-year follow-up, respectively. These cases underscore the variability in presentation and spinal level involvement of neurenteric cysts in children. MRI plays a central role in preoperative assessment, though definitive diagnosis relies on histopathology. Complete surgical excision remains the treatment of choice, offering favorable outcomes with low recurrence risk. The age extremes and differing anatomical locations in our cases reflect the broad clinical spectrum seen in pediatric patients. Spinal neurenteric cysts should be considered in children with unexplained spinal cord-related symptoms. Early imaging, accurate histological diagnosis, and total surgical excision are critical for optimal outcomes. Increased clinical awareness and case reporting will aid in improving recognition and management of this rare spinal lesion.