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Hammoud M, Cisse D, Chakour K, Chaoui MEF. Spinal epidermoid cyst associated with limited dorsal myeloschisis. Surg Neurol Int 2024; 15:169. [PMID: 38840610 PMCID: PMC11152525 DOI: 10.25259/sni_291_2024] [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] [Received: 04/15/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024] Open
Abstract
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.
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Affiliation(s)
- Marouane Hammoud
- Department of Neurosurgery, Medical School, University Sidi Mohammed Ben Abdellah, Hassan II University Hospital of Fez, Fez, Morocco
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2
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Alijani B, Karimzadhagh S, Abbaspour E, Reihanian Z, Haghani Dogahe M, Zaresharifi N. Intradural intramedullary epidermoid cyst in a 17-year-old male: An exceptionally rare case report and review of the literature. Int J Surg Case Rep 2024; 116:109331. [PMID: 38340621 PMCID: PMC10943664 DOI: 10.1016/j.ijscr.2024.109331] [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: 11/14/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Spinal epidermoid tumors are exceptionally rare, comprising less than 1 % of all spinal tumors. True intramedullary epidermoid cysts (IECs) are even more infrequent, constituting only 0.8 % of all spinal epidermoid tumors, with a notable cranial preference. Due to their gradual growth, the clinical presentation varies widely based on factors such as size, location, and the patient's age. CASE PRESENTATION A 17-year-old male patient was admitted after experiencing an eight-month-long gradual weakening of both lower limbs. Initially, he experienced paresthesia in the right lower extremities, which progressed to gait disturbances, impacting balance and coordination. Clinical examination indicated bilateral lower limb weakness, reduced vibration sense, and proprioception with a positive clonus sign and extensor plantar responses. Magnetic resonance imaging (MRI) revealed an intramedullary lesion at the T3-T4 level, appearing hypointense on T1-weighted and hyperintense on T2-weighted images. Subsequently, the patient underwent laminectomy of the T2-T5 vertebrae and microsurgical resection of the intramedullary lesion. Histopathological analysis confirmed the diagnosis of an epidermoid cyst. Following two months of physiotherapy, there was progressive improvement in the lower limb coordination and mobility. CLINICAL DISCUSSION Progressive neurological deficits emphasize the importance of comprehensive neurological evaluation. Diagnosis involves clinical manifestations, imaging, and histopathological examination. Patients often exhibit gradual motor weakness, sensory alterations, and varying degrees of pain. Advanced neuroimaging such as MRI aids diagnosis. Surgical resection is the primary treatment with potential complications. CONCLUSION A multidisciplinary approach is imperative for timely diagnosis and patient management, ensuring favorable outcomes while minimizing complications.
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Affiliation(s)
- Babak Alijani
- Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran; Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sahand Karimzadhagh
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Elahe Abbaspour
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Zoheir Reihanian
- Department of Neurosurgery, Poursina Hospital, Guilan University of Medical Sciences, Rasht, Iran; Guilan Road Trauma Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Nooshin Zaresharifi
- Department of Pathology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
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El Homsi M, Zadeh C, Charbel C, Alsheikh Deeb I, Gharzeddine K, Rebeiz K, Hourani R, Khoury N, Moukaddam H. Neurologic pathologies of the vertebral spine. Skeletal Radiol 2024; 53:419-436. [PMID: 37589755 DOI: 10.1007/s00256-023-04428-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
At some institutions, musculoskeletal and general radiologists rather than neuroradiologists are responsible for reading magnetic resonance imaging (MRI) of the spine. However, neurological findings, especially intrathecal ones, can be challenging. Intrathecal neurological findings in the spine can be classified by location (epidural, intradural extramedullary, and intramedullary) or etiology (tumor, infection, inflammatory, congenital). In this paper, we provide a succinct review of the intrathecal neurological findings that can be seen on MRI of the spine, primarily by location and secondarily by etiology, in order that this may serve as a helpful guide for musculoskeletal and general radiologists when encountering intrathecal neurological pathologies.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Catherina Zadeh
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa, IA, USA
| | - Charlotte Charbel
- Department of Radiology, Ichan School of Medicine at Mount Sinai, New York, NY, USA
| | - Ibrahim Alsheikh Deeb
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Karem Gharzeddine
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karim Rebeiz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nabil Khoury
- Department of Radiology, University of Iowa Hospital and Clinics, Iowa, IA, USA
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hicham Moukaddam
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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Wu P, Wang C, Jiang Y, Zhang Z, Gao J, Fan Z. Diagnosis and therapy of giant epidermoid double cysts with infection on the buttock: A case report and literature review. Medicine (Baltimore) 2024; 103:e37193. [PMID: 38335398 PMCID: PMC10861019 DOI: 10.1097/md.0000000000037193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
RATIONALE Epidermoid cyst (EC) is a common clinical condition and it can be filled with keratinized material. EC often represents painless, slow progressive growth, and single cyst. The cyst is usually 1 to 5 cm in size. Giant epidermoid cysts on the buttock area are extremely rare, and reports of giant epidermoid double cysts on the buttock are even rarer. PATIENT CONCERNS This paper reports a patient with a painless mass was on the left buttock. DIAGNOSIS A giant epidermoid double cysts with infection in a left buttock paranal location. INTERVENTIONS The mass was surgically removed. OUTCOMES The patient recovered well after surgical treatment and currently has no recurrence. CONCLUSION For patients with EC, MRI is recommended as a routine examination before surgery in order to detect the variation and extent of the cyst early. This lays a foundation for the complete resection of the lesion during the operation. The review of relevant literature will hopefully be helpful to clinicians.
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Affiliation(s)
- Peiliang Wu
- Department of General Surgery, the Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Cong Wang
- Department of General Surgery, the Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Yiran Jiang
- Department of Clinical Medicine (2020341116), China Medical University, Shenyang, China
| | - Zhi Zhang
- Department of Cardiology, the Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Junlan Gao
- Department of Critical Care Medicine, The Second Affiliated Hospital of Dalian Medical University Dalian, Liaoning, China
| | - Zhe Fan
- Department of General Surgery, the Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
- Liaoning Province Key Laboratory of Corneal and Ocular Surface Diseases Research, The Third People’s Hospital of Dalian, Dalian, China
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Retroz-Marques C, Correia AFA, Marques A, Gomes P. Epidural analgesia and tattoos: a modified technique to minimise risks and improve safety. BMJ Case Rep 2023; 16:e254058. [PMID: 38142054 DOI: 10.1136/bcr-2022-254058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
A healthy young woman with a sizeable lumbar tattoo was admitted to the delivery room in active labour at full-term gestation. She was experiencing strong, painful contractions and anxiety, concerned about the possible risks of receiving an epidural through a tattoo. Although there is little published evidence to suggest complications of performing an epidural through a tattoo, some studies report 'tissue coring phenomenon'. The anaesthesiology team informed the patient of the risks inherent in a traditional epidural and the potential long-term risks of receiving an epidural through the tattoo. Upon signing the informed consent form, the modified epidural technique was performed, and its administration proceeded without complications. A healthy boy was born 3.5 hours later in a vacuum-assisted delivery. This article describes the modified epidural technique designed to minimise tissue coring, and the results of 18 months of uneventful patient follow-up.
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Affiliation(s)
| | | | - Acilio Marques
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Piedade Gomes
- Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
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Alsulami FN, Alotaibi FM, Alfraidi LS, Alotaibi NF, Alnami RE, Alotaibi MF, Musllet RM, Alharbi A. A Pediatric Case of Spinal Intradural Epidermoid Cyst: A Rare Encounter. Cureus 2023; 15:e49970. [PMID: 38179394 PMCID: PMC10766006 DOI: 10.7759/cureus.49970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Intradural epidermoid cysts of the spine are rare congenital lesions. Their etiology is thought to stem from ectodermal remnants during embryonic development. They result in a diverse clinical presentation, often marked by an insidious onset and variable neurological deficits. Timely diagnosis is crucial for optimizing patient outcomes. We present the case of a 10-year-old male child presenting a six-month history of worsening back pain, intermittent leg weakness, and urinary incontinence. The physical examination revealed tenderness over the lower thoracic and lumbar spine, lower limb weakness, hyperreflexia, and sensory deficits. The diagnostic work-up, including cerebrospinal fluid analysis and magnetic resonance imaging, confirmed the presence of an intradural epidermoid cyst in the lumbosacral region. Surgical excision resulted in complete resection, with subsequent improvement in neurological deficits. This pediatric case underscores the importance of maintaining a high index of suspicion for unexplained neurological deficits. Characteristic imaging findings played a pivotal role in the diagnosis, guiding successful surgical intervention and achieving favorable outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Reema M Musllet
- General Practice, Princess Nourah Bint Abdul Rahman University, Riyadh, SAU
| | - Ahlam Alharbi
- Family Medicine, Primary Health Care Center, Riyadh, SAU
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Wang G, Shen H, Chu Z, Shen J, Zhu KC. Benign cervical intramedullary cyst without an epithelial lining:a case report. Br J Neurosurg 2023; 37:1664-1666. [PMID: 34009086 DOI: 10.1080/02688697.2021.1927983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 05/06/2021] [Indexed: 10/21/2022]
Abstract
This paper presents a female, benign intramedullary cyst case aged 66-year-old. During the operation, it was found that the cystic wall was very thin, and the cystic fluid was colorless and transparent. The lesion with the capsule was removed partially. Surprisingly, there was no epithelial lining on the capsule wall. It is very rare and different from the benign intramedullary cysts reported in the literature.
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Affiliation(s)
- GengHuan Wang
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - HePing Shen
- Neurology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - ZhengMin Chu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JianGuo Shen
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Kun Can Zhu
- Neurosurgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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Hussen E, Aboye S, Leake M, Nuredin Abrar F. Intramedullary Epidermoid Cyst of the Conus Medullaris: A Case Report and Literature Review. Int Med Case Rep J 2023; 16:521-527. [PMID: 37720363 PMCID: PMC10505022 DOI: 10.2147/imcrj.s430853] [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: 07/26/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
Background Central nervous system tumors are usually located in the brain, and spinal cord tumors account for approximately 20% of central nervous system tumors. Epidermoid cysts constitute <1% of all intraspinal tumors. It consists of squamous epithelial-lined cysts containing keratin, cholesterol, and cellular granules. Epidermoid cysts can be classified as congenital, acquired, extradural, extramedullary, or intramedullary according to etiology and location. The intradural intramedullary type is uncommon. Case Presentation An 11-year-old female patient had back pain with radiation to both lower extremities but worsened on the left side for 5 years. On neurological examination, motor strength was 3/5 for hip flexion and knee extension bilaterally and 5/5 for other key muscle groups. Contrast-enhanced lumbosacral magnetic resonance imaging (MRI) revealed T1 hypointense and T2 hyperintense lesions in the L2-L4 intramedullary conus and cauda equina. Laminectomy and near total resection were done, and histopathological examination revealed an epidermoid cyst. On the third postoperative day, the patient was discharged with completely resolved back pain and an improvement in lower extremity motor power. At monthly follow-up visits for a further 6 months, her back pain and weakness completely resolved, and she had no neurologic deficits. A postoperative lumbosacral MRI was done and confirmed near total excision of the tumor. Conclusion Intramedullary conus epidermoid cysts are rare but not unknown to neurosurgeons. MRI with diffusion-weighted images (DWI) is an imaging modality of choice. Asymptomatic patients can be conservatively treated. Once the patient has progressive symptoms and signs of compression, surgical excision is recommended. Meticulous electrocauterization may help decrease tumor regrowth in the remnant capsule, which is recommended. Avoiding leakage of cyst fluid into the subarachnoid space helps to avoid postoperative chemical meningitis. Radiotherapy is an option for the management of multiple recurrences.
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Affiliation(s)
- Endris Hussen
- Department of Neurosurgery, St. Paul’s Millennium Medical College, Addis Ababa, Ethiopia
| | - Samson Aboye
- Department of Neurosurgery, St. Paul’s Millennium Medical College, Addis Ababa, Ethiopia
| | - Merhawi Leake
- Minilik II Comprehensive Specialized Hospital, Addis Ababa, Ethiopia
| | - Fadil Nuredin Abrar
- Addis Ababa University College of Medicine and Health Sciences Hospital, Addis Ababa, Ethiopia
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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: 2] [Impact Index Per Article: 2.0] [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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Sarhan FM, Daqour AM, Abu-Harb ZH, Al-Darawish A, Ganaim FZ. Recurrent lumbar intraspinal epidermoid cyst presenting as lower back pain, a case report. Int J Surg Case Rep 2022; 97:107420. [PMID: 35853283 PMCID: PMC9403204 DOI: 10.1016/j.ijscr.2022.107420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/12/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Intraspinal Epidermoid Cyst (IEC) is a very-rare, yet one of the most benign tumors of the Central Nervous System (CNS). Very few cases of IEC were reported world-wide. Presentations depend on the location of the tumor with pain being the most common presenting symptom. CASE PRESENTATION A-35-year-old patient presented to the neurosurgical department for a regular follow up. Her history dates back to four years ago, when she first presented with back pain, which was later accompanied with fecal and urinary incontinence. Magnetic Resonance Imaging (MRI) showed a tumor at the level of L4-L5 which was surgically removed. Three years later, the patient presented to the clinic with similar symptoms. A repeat MRI showed a mass at L4-L5, which was surgically removed. Histological findings of both surgeries showed findings consistent with IEC. Currently the patient has no complaints. CLINICAL DISCUSSION IEC has various presentations. Our case presented with back pain, and urinary and fecal incontinence. Diagnosis depends on imaging and histology. MRI is the imaging modality of choice for those tumors in the CNS. Surgical removal is associated with high recurrence as a result of the suboptimal resection due to the strong adhesions between the capsule and the spinal cord. CONCLUSION Pain is the most common presenting symptom for IEC. Adjuvant radiotherapy, which should be implemented in the standard of care, is associated with a lesser degree of recurrence, in addition to regular follow-ups.
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Affiliation(s)
- Fajr M.A. Sarhan
- Al-Quds University-School of Medicine, Abu-Dis, East Jerusalem-West Bank, Palestine,Corresponding author.
| | | | - Zahra Hosam Abu-Harb
- Al-Quds University-School of Medicine, Abu-Dis, East Jerusalem-West Bank, Palestine
| | - Asaad Al-Darawish
- Al-Makassed Islamic Charitable Hospital, East-Jerusalem, West Bank, Palestine
| | - Fidaa Zakaria Ganaim
- Al-Quds University-School of Medicine, Abu-Dis, East Jerusalem-West Bank, Palestine
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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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Duong HD, Pham AH, Chu HT, Le TD, Pham DT, Van Dong H. Microsurgery for intradural epidermoid cyst at cauda equina level in a 9-year-old child: A case report. Int J Surg Case Rep 2021; 82:105932. [PMID: 33957405 PMCID: PMC8113878 DOI: 10.1016/j.ijscr.2021.105932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction and importance Epidermoid cysts are rare benign tumors. Here, we present a case of spontaneous intradural epidermoid cyst at cauda equina level in a 9-year-old patient, which we believed the first case to be reported in Vietnam. Case presentation A 9-year-old boy presented with 4 months of spontaneous left lower extremity muscle weakness and paresthesia. The MRI images suggested the diagnosis of intradural epidermoid cyst at cauda equina level. The patient underwent L5–S1 laminectomy and durotomy for tumor resection. The histology confirmed the diagnosis of epidermoid cyst. Post-operative images demonstrated total cyst removal. Clinical discussion The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. Conclusion Diagnosis of spinal epidermoid cyst is often delayed for its obscure presentation. Microsurgical dissection along with intra-operative mobile C-Arms enable total tumor resection while preserving spinal stability and neurological function. Follow-up with post-operative magnetic resonance imaging and tumor marker are helpful. Diagnosis of spinal epidermoid cyst is often delayed for its obscure presentation. Microsurgical dissection and mobile C-Arm enables total tumor resection while preserving stability and neurological function Magnetic resonance imaging and tumor marker are helpful in follow-up.
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Affiliation(s)
- Ha Dai Duong
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam.
| | - Anh Hoang Pham
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam
| | - Hung Thanh Chu
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam.
| | - Tam Duc Le
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery and Spine Surgery, Hanoi Medical University Hospital, Hanoi, Viet Nam
| | - Dung Tuan Pham
- Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam
| | - He Van Dong
- Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam
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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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