1
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Elmi Saad M, El Manouni O, Boutarbouch M, El Ouahabi A. Spinal intradural epidermoid cyst: Case report. Radiol Case Rep 2023; 18:2519-2521. [PMID: 37214325 PMCID: PMC10199400 DOI: 10.1016/j.radcr.2023.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/16/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023] Open
Abstract
Spinal epidermoid cysts are rare benign tumors. The etiology can be acquired or congenital. We present a rare case of an 18-month-old girl presented 4 months ago with spontaneous intergluteal swelling fistulized to the skin and lower limbs weakness. Magnetic resonance imaging of the spine demonstrated an intradural tumor from L3 to L5 levels, isointense on T1, hyperintense on T2-weighted images with contrast enhancement after gadolinium injection without any coexistent spinal dysraphism suggested the diagnosis of the dermal sinus. The patient underwent triple-level laminectomy for biopsy and tumor resection. A pearly white tumor was encountered, with a subsequent biopsy confirming it to be an epidermoid tumor. At 6-month follow-up, the neurologic deficit was improved. Spinal epidermoid cysts are rare tumors that evolve slowly. Complete total removal is the treatment of choice.
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Affiliation(s)
- Moussa Elmi Saad
- Corresponding author at: Dr. Moussa Elmi Saad, Department of Neurosurgery, Mohammed Vth University, School of Medicine, Hôpital des Spécialités ONO, Rabat, Morocco.
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2
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Elnoamany H, Salim M. Idiopathic lumbar epidermoid: review of literature and case report. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00188-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background
Spinal epidermoid tumors are rare, comprising of less than 1% of tumors involving the spine. These tumors arise from pathological displacement of epidermal cells into the spinal canal. Therefore, these tumors can be congenital, when there is improper closure of the neural tube; or acquired, in patients who have had prior lumbar punctures, trauma, or surgery. Spinal epidermoids are typically found in the lumbosacral region but can be found in other locations as well.
Case presentation
We report an original case of a 50 year old. He presented with 1 year with back pain and bilateral sciatica. The patient was neurological intact with no sphincter incompetence. The magnetic resonance image of the lumbosacral spine showed a 12 × 3 cm well-circumscribed intradural mass at the L3–S1 level. The patient was operated on with posterior lumbar laminectomy for tumor removal. Postoperation, the patient had improved pain and numbness. The motor power was intact as preoperative.
Conclusions
MRI with DWI is especially useful to confirm the diagnosis with the lesions appearing hyperintense. The most conventional approach to resection involved laminectomies and intradural tumor resection. GTR provided better outcomes in most cases even when the tumor was adherent to the nearby spinal cord or nerve roots.
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3
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Devathasan D, Murakami M, Miller MA, Thomovsky SA, Lewis MJ. Case Report: Recurrence of an Extradural Spinal Epidermoid Cyst Following Surgical Excision in a Dog. Front Vet Sci 2022; 9:871023. [PMID: 35498737 PMCID: PMC9051319 DOI: 10.3389/fvets.2022.871023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
Congenital epidermoid cysts are slow-growing, mass lesions caused by the abnormal inclusion of neuroectodermal tissue within the developing central nervous system. Subtotal excision of epidermoid cysts increases the risk of early recurrence of clinical signs. A 4-year-old female spayed boxer was presented with a 4-month history of ambulatory paraparesis and proprioceptive ataxia. Neurological examination localized a T3-L3 myelopathy. MRI revealed a T1 iso- to hypointense, T2 and FLAIR hyperintense, rim-enhancing mass at the level of the T9-T10 vertebrae resulting in extradural compression of the spinal cord. This was histopathologically confirmed as an extradural epidermoid cyst following subtotal excision. MRI performed 2 months post-operatively revealed a significant decrease of the lesion volume. The dog was neurologically normal following the surgery however re-presented 28 months later with recurrence of clinical signs. A 28-month post-operative MRI revealed substantial enlargement of the epidermoid cyst. The dog was subsequently taken for repeat decompressive surgery. At 6 months from the repeat surgery, the dog was neurologically static with mild proprioceptive deficits. The case report highlights the clinical and MRI features of a recurrent extradural spinal epidermoid cyst treated by subtotal excision.
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Affiliation(s)
- Dillon Devathasan
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
- *Correspondence: Dillon Devathasan
| | - Masahiro Murakami
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Margaret A. Miller
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Stephanie A. Thomovsky
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Melissa J. Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
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4
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Gao G, Chen Y, Tao B, Sun M, Bai S, Shang A. Early surgical intervention with antibiotic treatment for congenital dermal sinus with central nervous system infection: a retrospective study of 20 cases. World Neurosurg 2022; 164:e17-e23. [PMID: 35247614 DOI: 10.1016/j.wneu.2022.02.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the efficacy of surgical intervention with antibiotic treatment for congenital dermal sinus (CDS) with central nervous system infection. METHODS The clinical data of 20 patients with CDS and central nervous system infection were retrospectively analyzed. All patients received early surgical treatment combined with postoperative antibiotic therapy after the diagnosis was confirmed. The infection control effect was evaluated according to the clinical symptoms, laboratory examination results, and improvement of neurological function. RESULTS All 20 patients were treated with complete resection of the CDS and postoperative antibiotic therapy. No severe surgical complications occurred. All patients were followed up for 3-81 months with a median time of 37.5 months. Postoperative infection was effectively controlled with no recurrence. Neurological dysfunction and its related symptoms improved to varying extents after treatment, and the Spina Bifida Neurological Scale score at the final follow-up significantly increased. CONCLUSION Patients with CDS and central nervous system infection should be surgically managed at an early stage with antibiotic treatment. This treatment algorithm was effective to control infection and protect neurological function.
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Affiliation(s)
- Gan Gao
- Department of Neurosurgery, the First Medical Centre, Chinese PLA (People's Liberation Army) General Hospital
| | - Yanyan Chen
- Department of Anesthesiology, the 960th Hospital of the Chinese PLA (People's Liberation Army)
| | - Benzhang Tao
- Department of Neurosurgery, the First Medical Centre, Chinese PLA (People's Liberation Army) General Hospital
| | - Mengchun Sun
- Department of Neurosurgery, the First Medical Centre, Chinese PLA (People's Liberation Army) General Hospital
| | - Shaocong Bai
- Department of Neurosurgery, the First Medical Centre, Chinese PLA (People's Liberation Army) General Hospital
| | - Aijia Shang
- Department of Neurosurgery, the First Medical Centre, Chinese PLA (People's Liberation Army) General Hospital.
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5
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Karthigeyan M, Singh K, Salunke P, Gupta K. Co-existent epidermoid and dermoid in a child with spinal dysraphism. Childs Nerv Syst 2021; 37:2087-2090. [PMID: 33200294 DOI: 10.1007/s00381-020-04969-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/06/2020] [Indexed: 11/24/2022]
Abstract
Both spinal epidermoids and dermoids, given their common embryological origin, are referred as a single entity under the category of spinal inclusion tumors. Many theories, although speculative, have been proposed in relevance to their development. We present a unique case of dual pathology consisting of both epidermoid and dermoid components in a child with spinal dysraphism and succinctly touch upon the related embryological aspects and plausible pathogenesis. To the best of our knowledge, such co-existent entity has not been observed in the pediatric spine. The report adds to the gamut of the diverse observations of spinal dysraphic anomalies.
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Affiliation(s)
- Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India.
| | - Kavindra Singh
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Sector 12, Chandigarh, 160012, India
| | - Kirti Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
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6
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Maurya VP, Singh Y, Srivastava AK, Das KK, Bhaisora KS, Sardhara J, Behari S. Spinal Dermoid and Epidermoid Cyst: An Institutional Experience and Clinical Insight into the Neural Tube Closure Models. J Neurosci Rural Pract 2021; 12:495-503. [PMID: 34295103 PMCID: PMC8289537 DOI: 10.1055/s-0041-1724229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives
The spinal dermoid and epidermoid cysts (SDECs) are rare entities comprising less than 1% of pediatric intraspinal tumors. The present study aims to extrapolate the clinicoradiological data, in order to identify the most plausible neural tube closure model in human and provide a retrospective representation from our clinical experience.
Materials and Methods
We collected the details of all histologically proven, newly diagnosed primary SDECs who underwent excision over the past 20 years. Secondary or recurrent lesions and other spinal cord tumors were excluded. Surgical and follow-up details of these patients as well as those with associated spinal dysraphism were reviewed. Clinical and radiological follow-up revealed the recurrence in these inborn spinal cord disorders.
Results
A total of 73 patients were included retrospectively, having a mean age of 22.4 ± 13.3 years, and 41 (56.2%) cases fell in the first two decades of life. Twenty-four (32.9%) dermoid and 49 (67.1%) epidermoid cysts comprised the study population and 20 of them had associated spinal dysraphism. The distribution of SDECs was the most common in lumbosacral region (
n
= 30) which was 10 times more common than in the sacral region (
n
= 3). Bladder dysfunction 50 (68.5%) and pain 48 (65.7%) were the most common presenting complaints. During follow-up visits, 40/48 (83.3%) cases showed sensory improvement while 11/16 (68.7%) regained normal bowel function. There was no surgical mortality with recurrence seen in eight till the last follow-up.
Conclusions
The protracted clinical course of the spinal inclusion cysts mandates a long-term follow-up. The results of our study support the multisite closure model and attempt to provide a retrospective reflection of neural tube closure model in humans by using SDECs as the surrogate marker of neural tube closure defect.
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Affiliation(s)
- Ved P Maurya
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yashveer Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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7
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Gupta SK, Singh P, Gupta RK, Sharma R, Nehete LS. Infected congenital lumbosacral dermal sinus tract with conus epidermoid abscess: a rare entity. Childs Nerv Syst 2021; 37:741-747. [PMID: 33247382 DOI: 10.1007/s00381-020-04987-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Dermal sinus is more commonly associated with intradural dermoid than an epidermoid cyst. Conus epidermoid cyst with dermal sinus is a rare entity. We are presenting a rare case of infected conus epidermoid cyst along with the dermal sinus in an 18-month-old girl presented with flaccid paraparesis with sphincter dysfunction and timely intervention leads to complete recovery. We had searched PubMed for previously reported similar cases and did a case-based review of the literature. CASE REPORT This 18-month-old girl with discharging lumbosacral sinus with fever since 3 days presented with flaccid paraparesis with sphincter dysfunction. Preoperative magnetic resonance imaging (MRI) showed a large enhancing lesion from L1-S1 along with the dermal sinus tract. Complete excision of the cyst along with the sinus tract, followed by long-term antibiotic therapy. The excision of the infected cyst was done through myelotomy under neuromonitoring, while some part of the capsule densely adherent to the neural tissue was left behind. The patient gradually improved following surgery and motor power of the lower limbs were [Formula: see text] while going home. Histopathology revealed epidermoid cyst with secondary inflammatory tissue. Follow-up MRI of the spine showed excision of the dermal sinus tract and cyst with postoperative changes. At 1-year follow-up, the patient was asymptomatic without any focal deficits. CONCLUSION Early surgical intervention followed by long-term antibiotic therapy is a must for good functional recovery in patients of an infected dermal sinus tract with associated cyst. While excising cyst through myelotomy, some part of the capsule densely adherent to neural tissue may be left behind. Regular follow-up in the first year of surgery is essential to look for the recurrence of the lesion.
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Affiliation(s)
| | - Prashant Singh
- Department of Neurosurgery, AIIMS, Raipur, 492099, India
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8
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Intraspinal epidermoid and dermoid cysts-tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome. Acta Neurochir (Wien) 2020; 162:2895-2903. [PMID: 32524245 DOI: 10.1007/s00701-020-04446-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intraspinal epidermoid/dermoid cysts are very rare, benign tumors arising from pathological displacement of epidermal cells into the spinal canal. Literature data about the long-term outcome after microsurgical resection with multimodal intraoperative neurophysiological monitoring (IONM) are lacking. We analyzed one of the largest case series with special regard to intraoperative characteristics and long-term outcome after IONM-aided surgery. METHOD All 12 patients (m:f = 1.4:1) who underwent microsurgical tumor resection with multimodal IONM for intraspinal epidermoid/dermoid tumors between 1998 and 2019 in our university hospital were included. We retrospectively investigated the patients' characteristics, imaging/surgical parameters, and postoperative long-term outcomes. RESULTS Symptomatic tumor manifestation was seen during adulthood in 4 patients (median age 33.0 years) and during childhood in 8 patients (median age 4.3 years). Spinal dysraphism was the most often comorbidity (75%). The most frequent symptoms at diagnosis were spastic pareses (75%), ataxia (58%), and vegetative disorders (42%). Tumors were most often lumbosacral (L1-L5 42%, L5-S3 50%) and intradural-extramedullary (92%). For microsurgical resection, IONM with EMG, SSEPs, and TcMEPs of the limbs and pudendal nerve/anal sphincter was always applied and feasible; intraoperative corrective actions were initiated in three cases due to transient IONM deterioration. None of the patients showed a postoperative deterioration of the neurological status with a gross total resection rate of 92%. Pain situation, McCormick grade, and mJOA Score were improved at long-term follow-up (median 4.8 years). CONCLUSIONS IONM-aided resection of intraspinal epidermoid/dermoid tumors is feasible both in adult and pediatric cases and enables a satisfying clinical and surgical outcome.
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9
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De-La-Paz Y, Cherian I, Valencia-Bayona E, Alaswad M, Muñoz-Cobos A, Carrillo-Ruiz JD, Beltrán JQ. Lumbar dermoid cysts: 3 illustrative cases and a total review of the literature of the last two decades. Neurocirugia (Astur) 2020; 32:S1130-1473(20)30125-1. [PMID: 33132031 DOI: 10.1016/j.neucir.2020.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/01/2020] [Indexed: 11/29/2022]
Abstract
Spinal dermoid cysts are relatively infrequent tumors generally associated with a benign course. Here we describe three cases and analyzed the 109 cases of lumbar dermal cysts described in the literature in the last 20 years. We report a pediatric patient with a dermoid cyst posterior to a lumbar surgery for myelomeningocele repair with bad evolution; and two adult patients with the affection of the motor and autonomic function with good surgical outcomes. In approximately half of the reviewed cases, it was reported at least one complication. In fact, two cases had a fatal outcome. We discuss relevant characteristics of these lesions and those aspects probably associated with complications and bad outcomes.
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Affiliation(s)
- Yosselin De-La-Paz
- Department of Neurosurgery, General Hospital of Mexico, Dr. Balmis 148, Col. Doctores, Alcaldía Cuauhtémoc, CP 06720 Mexico City, Mexico
| | - Iype Cherian
- Department of Neurosurgery, Institute of Neurosciences, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar Metropolitan City-5, Biratnagar 56700, Nepal
| | - Edmundo Valencia-Bayona
- Department of Neurosurgery, Universitet Druzhby Narodov, Ulitsa Miklukho-Maklaya, 6, ZIP 117198 Moscow, Russia
| | - Mohammed Alaswad
- Department of Neurosurgery, Suez Canal University Hospital, The Ring Rd, El Sheikh Zayed, Ismalia Third, Ismailia Governorate, Egypt
| | - Arturo Muñoz-Cobos
- Department of Neurosurgery, General Hospital of Mexico, Dr. Balmis 148, Col. Doctores, Alcaldía Cuauhtémoc, CP 06720 Mexico City, Mexico; Department of Neurosurgery, Hospital Star Medica Chihuahua, Perif. de la Juventud 6103, Saucito, CP 31110 Chihuahua, Mexico
| | - José D Carrillo-Ruiz
- Psychophysiology and Neuroscience Coordination, Anahuac University, North Campus, Av Universidad Anáhuac 46, Lomas Anahuac, CP 52786 Estado de México, Mexico; Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Dr. Balmis 148, Col. Doctores, Alcaldía Cuauhtémoc, CP 06720 Mexico City, Mexico
| | - Jesús Q Beltrán
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Dr. Balmis 148, Col. Doctores, Alcaldía Cuauhtémoc, CP 06720 Mexico City, Mexico.
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10
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Congenital Spinal Cysts: An Update and Review of the Literature. World Neurosurg 2020; 145:480-491.e9. [PMID: 32822959 DOI: 10.1016/j.wneu.2020.08.092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023]
Abstract
Congenital spinal cysts are rare and encompass a wide variety of diseases including arachnoid, enterogenous, teratomatous, neurenteric, foregut, bronchogenic, epithelial, ependymal, dermoid, and epidermoid cysts. Here, we elucidate the epidemiology, pathology, pathogenesis, and diagnostic findings of the most common congenital spinal cysts, followed by a discussion of their presentation and treatment options. Differentiating the cause of each lesion is crucial for targeted clinical and surgical management for the patient. Our review describes how arachnoid cysts can be observed, fenestrated, percutaneously drained, or shunted; however, the primary goal for neurenteric, dermoid, and epidermoid cysts is removal. Further, we discuss how patient presentation is dependent on the rate of growth and location of compression on the spinal cord and nerve roots. However, although many of these lesions are discovered incidentally on imaging, the spectrum of possible symptoms include pain, weakness, ataxia, bladder incontinence, and progressive or acute neurologic deficits. We present and review the histology and imaging of a variety of cysts and discuss how although the goal of treatment is resection, the risks of surgery must be considered against the benefits of complete resection in each case.
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11
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Sîrbu OM, Chirteş AV, Mitricã M, Sîrbu CA. Spinal Intramedullary Epidermoid Cyst: Case Report and Updated Literature Review. World Neurosurg 2020; 139:39-50. [DOI: 10.1016/j.wneu.2020.03.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/17/2022]
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12
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Wang X, Gao J, Wang T, Li Z, Li Y. Intraspinal dermoid and epidermoid cysts: Long-term outcome and risk factors. J Spinal Cord Med 2020; 43:512-517. [PMID: 30517826 PMCID: PMC7480514 DOI: 10.1080/10790268.2018.1553008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: The literature on long-term outcome after resection of intraspinal dermoid and epidermoid tumors is limited. The purpose of this study was to review the progression-free survival (PFS), overall survival (OS), and long-term outcome in a consecutive series of 57 patients with intraspinal dermoid and epidermoid tumors. Design: Retrospective study. Methods: A total of 57 patients who underwent surgery at our institution between 2002 and 2010 were reviewed. Patients outcome were determined using the Japanese Orthopaedic Association score (JOA) and the McCormick score. Results: The follow-up data were 100% complete and the median follow-up time was 9.2 years. Gross total resection was performed in 21 patients (36.84%) and subtotal resection in 36 patients (63.16%). The PFS and OS at 8 years were 78.95% and 100% respectively. A good outcome was observed in 56.14% of patients based on the JOA and McCormick score. The univariate analysis showed that a tumor size of more than 4 cm, subtotal resection and sphincter disturbances were the influencing factors of poor outcome. Conclusion: The gold standard treatment for intraspinal tumors is gross total resection, but the operation needs to protect the remaining nerve function as much as possible and follow-up should be focused on patients with a high risk of poor outcome.
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Affiliation(s)
- Xin Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jun Gao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Tianyu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Zhimin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Yongning Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China,Correspondence to: Yongning Li, Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing100730, People’s Republic of China; Ph: 86-10-69152530, 86-10-69152530.
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13
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Rhodes RH. Congenital Spinal Lipomatous Malformations. Part 1. Spinal Lipomas, Lipomyeloceles, and Lipomyelomeningoceles. Fetal Pediatr Pathol 2020; 39:194-245. [PMID: 31342816 DOI: 10.1080/15513815.2019.1641859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Lumbosacral spinal lipomas and lipomyeloceles are usually identified in early childhood. Terminology, histopathology, and diagnosis for these malformations can be confusing. Materials and Methods: This is a PubMed review with comparison of embryology, gross, and histopathology, and reporting requisites for these and related closed spinal malformations. Results: The spinal lipoma group (congenital spinal lipomatous malformations) includes subcutaneous, transdural, intradural, and noncontiguous malformations stretching through the entire lower spinal region. This lipomyelocele trajectory overlaps the embryonic tail's caudal eminence. Histopathologically, the lipomyelocele spectrum is a heterogeneous, stereotypical set of findings encountered from dermis to spinal cord. Diagnosis requires detailed correlation of images, intraoperative inspection, and histopathology. Conclusions: Appropriate terminology and clinicopathologic correlation to arrive at a diagnosis is a critical activity shared by pathologist and clinician. Prognostic and management differences depend on specific diagnoses. Familial and genetic influences play little if any role in patient management in closed spinal malformations.
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Affiliation(s)
- Roy H Rhodes
- LSUHSC, Pathology, New Orleans, Louisiana, USA.,Rutgers Robert Wood Johnson Medical School, Pathology, New Brunswick, New Jersey, USA
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14
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Dodson V, Majmundar N, Sharer LR, Gillick JL. Epidermoid Cyst of the Lumbar Spine After Lumbar Puncture: A Clinical, Radiographic, and Pathologic Correlation. World Neurosurg 2020; 137:363-366. [PMID: 32058114 DOI: 10.1016/j.wneu.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Epidermoid cysts can rarely arise as a late complication of lumbar puncture. We describe a young man who had a remote history of a lumbar puncture and who was subsequently found to have a lumbar spinal epidermoid cyst on imaging, after presenting with lower extremity radicular pain. CASE DESCRIPTION A 24-year-old man with a remote history of lumbar puncture presented with lower back pain and radicular leg pain which had been ongoing for over a year. Despite conservative management, the patient's symptoms progressed to worsening back pain and left L4 radiculopathy. Magnetic resonance imaging of the lumbar spine demonstrated a peripherally enhancing, intradural, extramedullary lesion at L4-5. Diffusion-weighted imaging revealed diffusion restriction within the lesion, characteristic of an epidermoid cyst. The patient underwent an L4-5 laminectomy for resection of the intradural tumor. The lesion was noted to contain pearly white granules consistent with the appearance of an epidermoid cyst. Histopathology confirmed the diagnosis. On follow-up examination, the patient demonstrated improvement of his back pain and resolution of radicular symptoms. CONCLUSIONS Lumbar spinal epidermoid cysts may be either congenital or secondary to an iatrogenic cause. This patient had a remote history of lumbar puncture during workup for meningitis as a child. As a complication of a lumbar puncture, the formation of an epidermoid cyst can occur and is thought to be the result of implanted cutaneous tissue. This case provides a comprehensive illustration of the clinical, radiographic, intraoperative, and pathologic findings consistent with an iatrogenic epidermoid cyst.
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Affiliation(s)
- Vincent Dodson
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Neil Majmundar
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Leroy R Sharer
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - John L Gillick
- Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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Rkhami M, Gader G, Loukil B, Badri M, Zammel I. Iatrogenic Epidermoid Cyst of the Cauda Equina: A Late Complication of Lumbar Disc Herniation Surgery. World Neurosurg 2020; 133:271-274. [DOI: 10.1016/j.wneu.2019.10.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 10/11/2019] [Accepted: 10/13/2019] [Indexed: 11/24/2022]
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Turgut VU, Ekşi MŞ, Özak A, Özcan-Ekşi EE. Cervical intradural extramedullary epidermoid cyst at the background of congenital scoliosis with a semi-segmented C6 hemivertebra. Childs Nerv Syst 2019; 35:1411-1413. [PMID: 30953159 DOI: 10.1007/s00381-019-04144-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/29/2019] [Indexed: 11/24/2022]
Abstract
In the present case study, we present a female adolescent patient harboring a rare clinical presentation of spinal intradural extramedullary epidermoid cyst concomitant with congenital scoliosis. A 17-year-old female patient was admitted to the clinic with long-lasting neck pain. She was neurologically intact yet had cervicothoracic scoliosis. Cervical MRI and CT depicted a right C6 hemivertebra, fused to the lower endplate of the C5 vertebra. At the same vertebra level, she had an intradural extramedullary mass lesion anterior to the spinal cord. We planned to excise the mass lesion first. We used neuromonitoring during the surgery and made the surgery via posterior approach. We observed a pearl-like mass lesion anterolateral to the spinal cord. We excised the mass lesion with its capsule microsurgically via peace-meal route. She was neurologically stable following the surgery. Histopathological diagnosis was epidermoid cyst. Most of spinal inclusion cysts occur secondary to spinal dysraphism or iatrogenic inoculation. Isolated spinal inclusion cyst located anterior to the spinal cord concomitant with vertebral anomalies should be kept in mind before making proper surgical planning. Surgery is the modality of choice for spinal inclusion cyst and should be performed under the guidance of neuromonitoring, especially in cases with lesions located at higher spinal levels.
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Affiliation(s)
- Veli Umut Turgut
- Clinic of Neurosurgery, Antalya Atatürk State Hospital, Antalya, Turkey
| | - Murat Şakir Ekşi
- School of Medicine, Department of Neurosurgery, Acıbadem University, Göztepe Mah, Mesire Sok, Tütüncü Mehmet Efendi Cad, No:3/34, Tepekule Apart., Kadıköy, Istanbul, Turkey.
| | - Ahmet Özak
- Clinic of Neurosurgery, Antalya Atatürk State Hospital, Antalya, Turkey
| | - Emel Ece Özcan-Ekşi
- School of Medicine, Department of Physical Medicine and Rehabilitation, Bahçeşehir University, Istanbul, Turkey
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Intraspinal Inclusion Tumor After Myelomeningocele Repair: A Long-Term Single-Center Experience. World Neurosurg 2019; 122:e1338-e1344. [DOI: 10.1016/j.wneu.2018.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 01/30/2023]
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Beechar VB, Zinn PO, Heck KA, Fuller GN, Han I, Patel AJ, Ropper AE. Spinal Epidermoid Tumors: Case Report and Review of the Literature. Neurospine 2018; 15:117-122. [PMID: 29991240 PMCID: PMC6104727 DOI: 10.14245/ns.1836014.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022] Open
Abstract
Spinal epidermoid tumors are rare, benign tumors that are either acquired from trauma, surgery, or lumbar puncture or arise as congenital lesions, particularly spinal dysraphisms. We report a case of a massive spinal epidermoid tumor and review the literature with a focus on the surgical outcomes. A 71-year-old female patient presented after a fall with subsequent symptoms of severe back and hip pain, as well as loss of motor strength in the left leg. Her magnetic resonance imaging demonstrated a T2/short tau inversion recovery hyperintense mass extending from the level of the T10–11 disc caudally through S2. A biopsy was recommended to determine whether the tumor was radio- or chemo-sensitive. The patient underwent a L4 laminectomy and a pearly-white tumor was encountered, with a subsequent biopsy confirming it to be an epidermoid tumor. The following conclusions can be drawn from a review of the literature. Spinal epidermoid tumors are more common in women and tend to present in younger patients (median age of 23). The majority of patients had acquired lesions (46%). In terms of surgical outcomes for adherent tumors, gross total resection was found to provide optimal outcomes, with 90% of patients improving clinically after surgery.
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Affiliation(s)
- Vivek B Beechar
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Pascal O Zinn
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Kent A Heck
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - Inbo Han
- Department of Neurosurgery, CHA University, CHA Bundang Medical Center, Seongnam, Korea
| | - Akash J Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Alexander E Ropper
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Lin YP, Li YJ, Chen BL, Guo YH. Lumbar laminotomy and replantation for the treatment of adult spinal epidermoid cyst: A case report. Medicine (Baltimore) 2018; 97:e9334. [PMID: 29505514 PMCID: PMC5943114 DOI: 10.1097/md.0000000000009334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
RATIONALE Adult spinal epidermoid cyst (SEC) is a rare tumor. Lumbar laminectomy and tumor removal was a routine surgical procedure for adult spinal epidermoid cyst according to the literature, but postoperative lumbar instability and intractable low back pain may occur. In this study, we presented a brief report of an adult lumbar epidermoid cyst and introduced another surgical approach. PATIENT CONCERNS This 28-year-old woman has been complaining of the severe right buttock pain and right thigh radiating pain for half a year. She had been diagnosed as sacroiliitis, spinal arthritis, and lumbar disc herniation at 3 different hospitals before coming to our hospital. And she received a variety of conservative treatments, including non-steroidal anti-inflammatory drugs, aspirin, acetaminophen, glucocorticoids, acupuncture, physical therapy, and so on. However, her pain did not diminish at all. Finally, we find a space-occupying lesion in her lumbar magnetic resonance images (MRI). The lesion was slightly low, equal, and uneven equal-low signals on T1WI. T2WI showed slightly higher, equal, and uneven equal-high signals. And a thin-rim enhancement was observed on Gd-DTPA-enhanced MRI. DIAGNOSES Adult spinal epidermoid cyst. INTERVENTIONS The patient underwent a surgery of lumbar laminectomy, tumor excision, and spinous process-vertebral plate in situ replantation. OUTCOMES Postoperative pathology prompted that the tumor was cystoid. The patient's symptoms were completely removed 1 week after surgery. Three-month postoperative MRI confirmed that the spinal epidermoid cyst had been completely removed and three-dimensional CT prompted lumbar lamina in situ. Bony fusion occurred at 6 months after the surgery. LESSONS Lumbar laminotomy and replantation provides an ideal option to treat adult spinal epidermoid cyst because it can completely remove the cyst and simultaneously reduce the risk of iatrogenic lumbar instability.
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Satyarthee GD, Kumar A, Moscote-Salazar LR. Conus medullaris dermoid tumour. Uncommon presentation of conus medullaris dermoid as an exophytic mass lesion. ROMANIAN NEUROSURGERY 2017. [DOI: 10.1515/romneu-2017-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Authors report an extremely uncommon case dorsally exophytic conus dermoid in a three-years old boy, who underwent meningocele repair locate at lumbosacral region at an age of one month. The boy presented with low backache and difficulty in passing urine. Magnetic resonance imaging evaluation of spine revealed presence of a large exophytic mass located dorsally in the conus and the features suggestive of dermoid. He underwent surgical intervention during surgery lesion was dorsally exophytic containing cheesy material with hairs, excision of dermoid along capsule was carried our successfully. Pertinent literature and management of exophytic conus dermoid is discussed briefly.
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Sivaraju L, Thakar S, Ghosal N, Hegde AS. Primary intradural sacral epidermoid in a nondysraphic spine: Case report and review of literature. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:105-8. [PMID: 27217657 PMCID: PMC4872558 DOI: 10.4103/0974-8237.181866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The occurrence of epidermoids within the spinal canal is uncommon. Most of the reported spinal epidermoids (SEs) have been described in the thoracic or lumbar regions. They occur either following trauma or in the setting of coexistent spinal dysraphism. The authors describe an unusual case of a 28-year-old lady who presented with long-standing back pain and urinary incontinence. Magnetic resonance imaging (MRI) of her spine demonstrated a sacral SE without any coexistent spinal dysraphism. The diagnosis of an epidermoid was confirmed by histopathological examination following laminectomy and excision. To the authors’ best knowledge, this is the third case of a sacral SE occurring in a non-dysraphic spine. The case is discussed in the light of a relevant literature review.
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Affiliation(s)
- Laxminadh Sivaraju
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Sumit Thakar
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Nandita Ghosal
- Department of Pathology, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
| | - Alangar S Hegde
- Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Abstract
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.
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Affiliation(s)
- Dominic N P Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children, London, WC1N 3 JH, UK.
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