Dorsal intramedullary dermoids

A Commoner at an Extremely Rare Site: A Case of Dorsal Intramedullary Spinal Dermoid Cyst

Intramedullary dorsal dermoid cysts are rare benign tumors, arising from the nests of embryonic ectoderm, which get buried or trapped under the lines of fusion of the ectodermal folds in the developing embryo. We present a rare case of intramedullary dermoid cyst in a 30-year-old asymptomatic female, who presented with paraplegia and ataxia. Magnetic resonance imaging was suggestive of neoplastic intramedullary mass. Intraoperatively, findings were suspicious of tuberculosis, but on final histopathological evaluation, the final and definitive diagnosis of intramedullary dermoid cyst was rendered. The postoperative phase was uneventful.

Diagnosing a rare thoracic intramedullary spinal dermoid cyst using DWI with ADC mapping: Case report

Introduction

Dermoid cysts are rare lesions generally associated with embryological errors that occur during neural tube closure. Intramedullary lesions are extremely rare, especially within the upper thoracic spinal cord.

Case presentation

We report a case of a 19-year-old male who had an intramedullary thoracic dermoid cyst presenting with progressive ataxia, lower limb weakness, and hyperreflexia. MRI demonstrated a 1.2 × 1.8-cm intramedullary thoracic dermoid cyst causing significant spinal cord compression, which was successfully removed via full resection. The patient had an uncomplicated postoperative course, with improvement in preoperative deficits.

Discussion

This is a unique case documenting a thoracic spinal cord intramedullary dermoid cyst not associated with trauma or congenital abnormality of the spinal cord.

Conclusion

We highlight the importance of future inclusion of diffusion-weighted magnetic resonance (MR) imaging (DWI) with apparent diffusion coefficient (ADC), an imaging modality that detects differences in cellularity of spinal cord lesions, for earlier diagnosis of dermoid cyst.

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This is a unique case of intramedullary dermoid cyst not associated with trauma or congenital abnormality.

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Diffusion-weighted magnetic resonance (MR) imaging (DWI) with apparent diffusion coefficient (ADC) was used to detect differences in cellularity of the spinal cord lesion.

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We recommend future use of DWI and ADC mapping for early detection of intramedullary neoplasms.

Intradural intramedullary dermoid cyst in a 42-year-old man at the L1-L2 region

Background

Intramedullary dermoid cysts within the spine are a rare benign tumor. We present this case, which has atypical presenting symptoms, in order to increase awareness of intradural dermoid cysts.

Clinical presentation

We present here a case of a 42 year old man with a 12-month history of lumbar spinal pain as well progressive left lower extremity loss of strength, as well as numbness and paresthesia radiating into the left foot. Magnetic resonance imaging scan revealed a 4 × 1 × 1.3cm intradural mass at the cauda equina L1-L2 region and was hyperintense in both T1 and T2 causing cord compression. L1-L2 laminectomy and intradural micro resection were performed with successful excision of the suspicious mass. Histopathological review revealed keratinaceous debris and adnexal structures consistent with a dermoid cyst.

Conclusions

Our case is unusual with the other reported cases of dermoid cysts due to superior involvement in the lumbar region compared to other case reports with predominantly lumbosacral involvement. This location of the cyst lead to radicular symptoms, rather than lumbosacral pain and sphincter incompetence that is more commonly represented in the literature

Clinical Presentation and Surgical Outcomes Based on Age and Tumor Topography in 59 Patients With Spinal Dermoid Cysts

BACKGROUND

Differences in presentation and outcomes in children and adults with spinal dermoid tumors have not been documented. Surgical outcomes for dermoid tumors in different spinal cord planes have also not been studied.

METHODS

Retrospective review of 59 consecutive patients who underwent surgery for intraspinal dermoid tumors at a single institution. Tumors were categorized as purely extramedullary (n = 15), purely intramedullary (n = 28) or intramedullary-extramedullary (n = 16) based on intraoperative and imaging findings.

RESULTS

The cohort was composed of 45 children and 14 adults. The presence of a dermal sinus and prior history of meningitis was significantly associated with childhood presentation (P = 0.001 and P = 0.013, respectively). Most adults had purely intramedullary tumors (n = 12, 85.7%) as compared to children (35.6%, P = 0.001). Gross total resection (GTR) was achieved in 33.3% and 41.7% of children and adults, respectively (P = 1.000). Factors associated with GTR on logistic regression analysis included short segment (≤3 levels) dermoid cysts (P = 0.037) and absence of an intramedullary component (P = 0.027). Forty-seven patients were followed up over a mean period of 72.9 ± 8.3 months. Preoperative motor deficits were more likely to improve in children than in adults (P = 0.005). Recurrences were seen in 14.9% of cases (all with intramedullary tumors) at a median interval of 58 months (range: 40-166 months) after surgery, with no differences in recurrence-free survival between children and adults (P = 0.936).

CONCLUSIONS

Presentation of dermoid cysts is distinctively different in children and adults. GTR is a challenge for intramedullary and large tumors. Recurrences may manifest several years after surgery, mandating life-long surveillance.

Growth of Intramedullary Spinal Cord Dermoid Cyst from a Congenital Thoracic Dermal Sinus Tract after Negative Screening Ultrasound Imaging

INTRODUCTION

Intramedullary thoracic dermoid cysts are rare lesions that are associated with dermal sinus tracts (DSTs). Current recommendations advocate for imaging-based screening of suspected DSTs shortly after birth to exclude associated inclusion lesions.

CASE PRESENTATION

A 6-year-old male child presented with a 2-week history of progressive ataxia, lower limb weakness, and hyperreflexia. He was suspected to have a thoracic DST at birth, though initial screening ultrasound was negative for an inclusion lesion or intradural tract. On representation, MRI demonstrated a 3.9-cm intramedullary thoracic dermoid cyst causing significant spinal cord compression. Intraoperatively, a DST extending intradurally was found. The associated dermoid cyst was removed via intracapsular resection.

CONCLUSIONS

Whilst dermoid cysts are presumed to progressively develop from DSTs, to our knowledge, this is the first case in English literature documenting a thoracic spinal cord intramedullary dermoid cyst following a negative screening ultrasound for a suspected DST. We use this case to highlight the false-negative rates associated with postnatal screening and advocate for early neurosurgical referral of suspected DSTs, regardless of imaging findings.

A rare case of intramedullary spinal dermoid cyst in adult: A case report

INTRODUCTION

Intramedullary spine dermoid cysts are rare and benign tumors that occur mainly due to the defective closure of the neural tube during the development process. They are slow-growing tumor that manifest in the second and third decades of life. The prevalence of intramedullary dermoid cysts is only 1%.

PRESENTATION OF CASE

We reported a 30 years old female with chief complain of weakness of the right leg in the last 6 months before admission. She complained about back pain and had history of scoliosis. In MRI we found intramedullary tumor at level T11-L1. We performed marginal excision and sent the sample for histopathological examination. The histopathological result was dermoid cyst tumor.

DISCUSSION

During six months of post-operative period, no recurrence was detected, and a complete relief of symptoms is as expected. Early diagnosis is needed for proper handling and to achieve good outcomes.

CONCLUSION

Dermoid cysts in adults without a history of trauma are a rare case. Surgical excision is the choice of treatment. However, long-term follow up is needed to monitor the sensory-motor function.

A review on five cases of intramedullary dermoid cyst

PURPOSE

Intramedullary dermoid cyst is a type of rare congenital intraspinal lesions. Its proximity and its strong adherence to the surrounding spinal cord tissue often make a complete resection of the cyst wall problematic. We retrospectively studied five cases of intramedullary dermoid cyst, focusing the recurrence of intramedullary dermoid cyst after surgery and the probable method to prevent the recurrence.

METHODS

Five cases of intramedullary dermoid cyst with or without other concomitant deformities were retrospectively reviewed. Subjects consisted of three males and two females, aged 2–24 years. Diagnosis was confirmed by spinal MRI and pathology studies. Surgical outcomes were analyzed. In case 2, an Ommaya reservoir was implanted in the cystic cavity, and the cystic content was sucked though the Ommaya reservoir. An 18–113 months of follow-up was conducted.

RESULTS

The contents of intramedullary dermoid cyst were loose and easy to be cleared in the operations. The cyst wall was closely adhered to the spinal cord, and complete resection was difficult. During the follow-up of 18–113 months, the lesion reoccurred in three cases.

CONCLUSION

Intramedullary dermoid cyst is prone to recurrence. The presence of residual cyst wall might be the cause of dermoid cyst recurrence. When a complete resection of cyst wall becomes infeasible, placement of an intraspinal Ommaya reservoir may help to delay and minimize clinical symptoms by aspiration of cystic contents in case of recurrence.

Congenital dermal sinus in mid-dorsal spine with large intramedullary dermoid cyst in an 18-months-old child

Intramedullary dermoid cyst is a rare entity. It is usually associated with spinal dysraphism and dermal sinus. Our case is an 18-months-old female child who presented with history of fever and mild difficulty in moving left leg. She had a sinus in mid dorsal spine since birth with history of intermittent discharge from it. On magnetic resonance imaging of spine she was diagnosed to have large intramedullary epidermoid/dermoid cyst in the D2-7 vertebral level with a sinus tract. A dermoid cyst along with the sinus tract was excised. Post-operative follow up period was uneventful with full recovery.

Spinal inclusion cysts

BACKGROUND

Dermoid and epidermoid tumours are related though pathologically distinct entities that can be combined under the term inclusion cysts. Most are of developmental origin and in the spine may be intramedullary, intradural extramedullary or extraspinal in location. The terminology, aetiology, radiology and optimal management of spinal inclusion cysts have been the source of ongoing controversy.

AIMS

A retrospective review of surgical cases from a single institution has been conducted, and this experience is discussed in the context of the existing literature.

RESULTS

Sixteen cases of paediatric spinal inclusion cysts were treated between 2002 and 2012. Associated anomalies included dermal sinus track (11), previous myelomeningocele (4) and Currarino syndrome (1). The lesions spanned 1-8 spinal levels; in half the cases, there was a history of secondary infection at the time of presentation. The aim of treatment was complete excision, and macroscopic removal was achieved in all cases. The most significant adverse outcome was related to sphincter dysfunction, and this was observed in four cases, two with a prior history of myelomeningocele and two who had presented with active infection. No instances of recurrence were recorded during a median follow up of 7.4 years (range 1-11 years).

CONCLUSIONS

Spinal inclusion cysts are aetiologically diverse lesions, though in paediatric practice, most occur in association with a dysraphic anomaly. There are no consistent clinical or radiological features that will reliably distinguish between dermoid and epidermoid, and both may result in symptoms from mass effect or infection. The recurrence rate is low if complete macroscopic resection can be achieved.

Intramedullary dermoid cyst with relatively atypical symptoms: a case report and review of the literature

Background

Intraspinal dermoid cysts are rare and benign tumors that occur primarily due to the defective closure of the neural tube, an ectodermal derivative, during the process of development. They are slow-growing tumors manifesting in the second and third decades of life.

Case presentation

We present here a case of a 14-year-old Sindhi boy with a six-month history of paraparesis of the lower limbs and a progressive loss of power of grade 3/5, and hypoesthesia in the L4/L5 dermatomes of his right lower limb. A plain magnetic resonance imaging scan revealed a well-demarcated intraspinal intramedullary cyst containing an abscess at the level of T12 and L1 causing localized cord compression, which was producing the symptoms. Near total excision of the cyst was successfully performed and was sent for biopsy, which revealed keratinocytes and keratin flakes. With one month of follow-up, along with physiotherapeutic management, the patient gradually improved and was able to walk without support.

Conclusions

Critical evaluation of every case with aggravating symptoms should be carried out, and neurological and radiological examinations should be conducted to ensure the well-being of patients.

Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management

The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. An overview of the pathologic processes of this region is provided. Epidemiological, clinical and neuroradiological characteristics of neoplastic (glial tumors, non-glial tumors, metastasis, primary melanomas) and non-neoplastic lesions (granulomatous lesions, abscess, parasitic infections, vascular, demyelinating and dysembryogenetic lesions) are discussed. Main MR imaging characteristics used to differentiate neoplastic from non-neoplastic lesions consist in pathological spinal cord expansion, gadolinium-enhancement and tumoural cyst formation. Management strategies differ substantially, depending on the kind of lesion. According to the suspected pathological entity radical resection, biopsy or conservative treatments are reasonable options. Intraoperative electrophysiological monitoring is a fundamental part of the surgical setting.

Intramedullary dermoid in a low lying conus tethered by a fatty filum - embryological implications

Intramedullary dermoids arising within the conus medullaris are rare. We report a rare association of an intramedullary dermoid cyst located in a low lying conus tethered by a thickened, fatty filum terminale and discuss the embryological implications of this association.

Imagerie des lésions kystiques du canal rachidien chez l’adulte

Intrarachidian cystic lesions are frequent, with highly varied causes. They can be classified according to their location into intramedullary cystic lesions and extramedullary cystic lesions. In these two categories, they can then be regrouped according to the tissue from which they develop. MRI is the first-choice examination for the study of the intracanal contents and the differential diagnosis between the various lesions.