Management of a pediatric neuroenteric cyst with persistent double dorsal aortae and anterior meningocele: illustrative case.

backgroundNeuroenteric cysts are exceedingly rare congenital anomalies. Although the exact pathogenesis is incompletely understood, neuroenteric cysts can arise when foregut duplication cysts extend into the spinal canal. This process is likely related to failure of endodermal cell separation from ectodermal counterparts during week 3 of development, and symptoms depend on location and degree of encroachment on surrounding structures. Complete resection remains the treatment of choice with the lowest incidence of recurrence, but the optimal surgical approach is debated. Associated congenital anomalies can add surgical complexity. OBSERVATIONS: The authors present the case of a 7-week-old infant diagnosed with a large mediastinal extradural neuroenteric cyst, along with multiple other congenital anomalies. A combined thoracic and laparoscopic abdominal approach was required for complete resection. LESSONS: This case illustrates the importance of multispecialty collaboration, advanced imaging for preoperative planning, and thoughtful timing of intervention. A combined thoracoscopic/thoracotomy and laparoscopic approach, while surgically demanding, was safe and provided excellent visibility for complete resection of the large neuroenteric cyst. https://thejns.org/doi/10.3171/CASE24894.