Intramedullary epidermoid cysts in adults: Case report and updated literature review

Spinal epidermoid cyst associated with limited dorsal myeloschisis

Background

Epidermoid cysts (ECs) are rare benign tumors arising from epidermal cells, associated with congenital abnormalities or acquired through trauma, surgery, or lumbar punctures. They represent <1% of all intraspinal tumors and may be associated with limited dorsal myeloschisis (LDM).

Case Description

A 7-year-old neurologically intact male had a dorsal skin mass since birth located posteriorly in the midline of the inferior thoracic spine. The mass was palpable, painless, mobile, vascularized, and could be transilluminated. Thoracic magnetic resonance imaging showed an extensive intradural extramedullary cystic lesion extending from D6 to D8 that did not enhance with contrast, accompanied by a subcutaneous fluid collection at D8-D9 communicating with the subarachnoid space. The patient underwent gross total resection of the lesion, pathologically confirmed as an EC. The postoperative course was uneventful, with no recurrence 1 year postoperatively.

Conclusion

LDM may be associated with ECs. Early diagnosis and surgical resection of these lesions are essential for favorable outcomes.

Do prophylactic steroids prevent chemical meningitis in surgery for epidermoid cysts? Case report and literature review

Background:

Cranial and spinal epidermoid cysts (ECs) are rare and surgical resection can be complicated by chemical meningitis. Here, we treated a patient undergoing surgical resection of an intramedullary spinal EC with prophylactic steroids to help prevent postoperative chemical meningitis. Notably, we found a paucity of evidence regarding the efficacy of steroids used for this purpose.

Case Description:

A 44-year-old male presented with a rare intramedullary thoracic EC. He was given oral dexamethasone postoperatively and did not subsequently develop chemical meningitis. Here, we reviewed the current literature regarding the efficacy of steroid use for this purpose, utilizing multiple electronic databases (Ovid MEDLINE, Ovid EMBASE, and Scopus). We found only three studies (one case report, one case series, and a randomized controlled trial), that involved patients who received steroids. Of the 24 patients given prophylactic steroids, none developed fever or meningismus. One patient received 8 days of oral dexamethasone. Eleven patients received intraoperative hydrocortisone irrigation alone, while final 12 patients received intraoperative hydrocortisone irrigation plus a 3 week postoperative tapering course of oral steroids. Notably, all of the nine patients who did not receive any steroids developed postoperative fever, with 78% demonstrating meningismus.

Conclusion:

Here is level II evidence that establishes the efficacy of prophylactic steroids utilized in patients undergoing surgery for ECs to prevent postoperative chemical meningitis. Nevertheless, there is still no current consensus regarding either the type of steroid utilized, or the route of administration.

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.

Intramedullary Masses of the Spinal Cord: Radiologic-Pathologic Correlation

Spinal cord tumors are a challenge for patients and neurosurgeons because of the high risk of neurologic deficits from the disease process and surgical interventions. Spinal cord tumors are uncommon, and approximately 2%-3% of primary intra-axial tumors of the central nervous system occur in the spinal cord. Primary intra-axial tumors are usually derived from neuroepithelial tissue, especially glial cells. This often leads to a classic intramedullary mass differential diagnosis of ependymoma or astrocytoma, which together constitute up to 70% of spinal cord tumors. For example, ependymomas occur predominantly in adults, and astrocytomas (specifically pilocytic astrocytomas) occur predominantly in children. While that is an excellent starting point, in order to refine the differential diagnosis, the authors review the radiologic-pathologic features of specific neoplastic categories and entities recognized by the World Health Organization (WHO) in the 2016 WHO Classification of Tumours of the Central Nervous System and a few additional congenital-developmental entities. Radiologists can add value by providing a reasonable preoperative differential diagnosis for the patient and neurosurgeon, in many cases by favoring the most common conditions, and in other cases by identifying radiologic features that may point toward a less common entity. Some of the less common entities include intramedullary myxopapillary ependymoma, spinal subependymoma, and spinal hemangioblastoma. Whenever possible, the characteristic imaging features and locations of these tumors are explained or traced back to the underlying cell of origin and findings seen at histopathologic examination.See discussion on this article by Buch.

A Rare Case of Infected Cervicodorsal Intramedullary Epidermoid Cyst

Introduction  Intramedullary spinal epidermoid cysts have a reported incidence of less than 1% of intramedullary spinal cord tumors; and out of these, intramedullary epidermoid lesions within the cervical spinal cord are even rarer. Here, we present the case of an adult patient with an infected intramedullary epidermoid cyst, identified on magnetic resonance imaging (MRI) at the C7–D1 level that was successfully excised without any worsening of neurological status.

Case Presentation A 23-year-old female patient presented with history of moderate degree intermittent fever followed by gradually progressive right-sided weakness. She had paresthesia below C5 dermatome on the right side. On close inspection of 
the back, a tiny sinus opening was noted at the D2 level near the midline. MRI of the spine showed an intramedullary lesion at the C6–D1 level with the tract connecting to the subcutaneous lesion. Somatosensory evoked potential (SSEP) monitoring was done during the surgery with near total excision of the lesion.

Conclusion Even though the location is rare, a differential diagnosis of the epidermoid should always be considered. A tiny dermal sinus opening helped us in proper diagnosis, along with surgical excision, by providing us a direct path to the intramedullary lesion. An early diagnosis and treatment with neurophysiological monitoring helped us in the maximum safe resection of the lesion without developing any new deficit.

Subependymoma of the Conus Medullaris with Cystic Formation: Case Report and a Literature Review

BACKGROUND

Subependymoma in the spinal cord is very rare and usually occurs in the cervical cord. We report an exceptional case of subependymoma that occurred at the conus medullaris with cystic formation. This article reviews the literature on subependymoma in the conus medullaris; discusses its clinical manifestations, imaging findings, and differential diagnoses; and offers an opinion about the cystic formation of the subependymoma.

CASE DESCRIPTION

A 69-year-old woman experienced progressive limb weakness with a somatosensory abnormality for 3 months. Preoperative magnetic resonance imaging showed a cystic intramedullary lesion at the conus medullaris with a well-defined margin. A preliminary diagnosis of epidermoid cyst was made based on the imaging findings. During the operation, cystic formation of the tumor was found, and the tumor was completely removed. Pathology showed an uneven proliferation of glial cells, consistent with subependymal morphology, and the tumor was confirmed as subependymoma.

CONCLUSIONS

We present an extremely rare case of cystic formation in subependymoma at the conus medullaris. Subependymoma should be included in the differential diagnosis of intramedullary cystic lesions. The breakdown of the blood-brain barrier and excessive extravasation may be potential mechanisms of cystic formation.

Adult intramedullary epidermoid cyst without spinal dysraphism: A case report

Background:

Intramedullary epidermoid cyst (IEC), typically associated with spinal dysraphism, is rare, with fewer than 80 such cases reported in the literature. Here we present an adult with an IEC without spinal dysraphism.

Case Description:

A 41-year-old female presented with the gradual onset of a progressive spastic paraparesis attributed to a magnetic resonance imaging (MRI)-documented D8-9 intramedullary lesion. Following microsurgical excision of the IEC, she fully recovered.

Conclusion:

IECs are rare lesions, typically found in conjunction with spinal dysraphism. Utilizing MRI studies to document the lesion location, gross total microsurgical excision is the procedure of choice. Early excision of these benign lesions maximizes functional recovery.