1
|
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: 5] [Impact Index Per Article: 1.3] [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.
Collapse
|
2
|
Kaur M, Aggarwal A, Sharma A, Malik A. Cervical Lipomyelocele with Congenital Inclusion Cyst. World Neurosurg 2019; 130:122-128. [DOI: 10.1016/j.wneu.2019.06.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
|
3
|
Musali SR, Mohammed I, Gollapudi PR, Maley SK. Dorsal Spinal Intradural Intramedullary Epidermoid Cyst: A Rare Case Report and Review of Literature. J Neurosci Rural Pract 2019; 10:352-354. [PMID: 31001035 PMCID: PMC6454963 DOI: 10.4103/jnrp.jnrp_304_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Epidermoid cysts are commonly seen intracranial lesions but their occurrence in the spine is rare. They account for <1% of all the benign tumors of the spine. These are benign epithelial-lined cysts filled with keratin. They are classified into two types: congenital or acquired. Congenital epidermoid cysts are more commonly associated with spinal dysraphic states such as syringomyelia, dermal sinus and spina bifida whereas the acquired cysts are associated with repeated lumbar punctures. Based on the location, they can be extradural, intradural, extramedullary, or intramedullary. Most of the epidermoids are intradural extramedullary. Intramedullary epidermoid cysts are very uncommon. We report a case of a 6-year-old female patient with dorsal epidermoid cyst with neurological deficits. Magnetic resonance imaging of the spine showed a well-defined lesion from D9 to D12 which was hypointense on T1W1 and heterogeneously hyperintense on T2W2. Surgery was performed to excise the lesion and to decompress the spinal cord. Histopathological examination of the excised lesion confirmed it as an epidermoid cyst.
Collapse
Affiliation(s)
- Siddartha Reddy Musali
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
| | - Imran Mohammed
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
| | - Prakash Rao Gollapudi
- Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India
| | - Sai Kumar Maley
- Department of Pathology, Osmania Medical College, Hyderabad, Telangana, India
| |
Collapse
|
4
|
Asmaro K, Abouelleil M, Haider S, Zakaria HM, Gradinaru C, Mukherjee A, Lee I. Malignant Transformation of a Filum Terminale Dermoid Tumor into Adenocarcinoma. World Neurosurg 2019; 127:15-19. [PMID: 30872204 DOI: 10.1016/j.wneu.2019.03.031] [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: 12/28/2018] [Revised: 03/03/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Intraspinal dermoid tumors are usually rare benign growths that occur as a result of defects during neural tube formation. They make up less than 1% of tumors in the spine and are associated with spinal dysraphisms or sinus tracts. Although rare, malignant transformation into squamous cell carcinoma has been previously reported. Malignant transformation into adenocarcinoma, however, represents a novel phenotypic differentiation pattern that is hitherto undescribed. CASE DESCRIPTION A 45-year-old woman presented with acute symptoms of cauda equina syndrome. Imaging of the spine revealed a large intradural sacral mass. The lesion was surgically resected with pathology revealing a dermoid tumor with malignant transformation into adenocarcinoma. Metastatic workup revealed no other suspicious lesions. The patient had an uneventful postoperative course, gradually regaining micturition control. CONCLUSIONS Dermoid tumors, also known as benign cystic teratoma or mature teratoma, are usually benign congenital tumors comprising epithelial cells that arise from displaced embryonic ectoderm and mesoderm during neural tube formation. Although extremely rare, malignant transformation into squamous cell carcinoma has been reported. This case represents the first report of an intraspinal dermoid tumor transforming into adenocarcinoma. A comprehensive histopathologic analysis is key to identifying the lesion and guiding postsurgical management.
Collapse
Affiliation(s)
- Karam Asmaro
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA.
| | - Mohamed Abouelleil
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Sameah Haider
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| | | | - Ciprian Gradinaru
- Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA
| | - Abir Mukherjee
- Department of Pathology, Henry Ford Health System, Detroit, Michigan, USA
| | - Ian Lee
- Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
5
|
Multi-Segmental Intramedullary Epidermoid Cyst Causing Low Back Pain and Urologic Dysfunction. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.9310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
6
|
Mishra SS, Satapathy MC, Deo RC, Tripathy SR, Senapati SB. Isolated thoracic (D5) intramedullary epidermoid cyst without spinal dysraphism: A rare case report. J Pediatr Neurosci 2015; 10:133-6. [PMID: 26167216 PMCID: PMC4489056 DOI: 10.4103/1817-1745.159206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Spinal epidermoid cyst, congenital or acquired, is mainly congenital associated with spinal dysraphism, rarely in isolation. Intramedullary epidermoid cysts (IECs) are rare with less than 60 cases reported so far; isolated variety (i.e., without spinal dysraphism) is still rarer. Complete microsurgical excision is the dictum of surgical treatment. A 14-year-old boy presented with 4-month history of upper backache accompanied with progressive descending paresthesia with paraparesis with early bladder and bowel involvement. His condition deteriorated rapidly making him bedridden. Neurological examination revealed upper thoracic myeloradiculopathy probably of neoplastic origin with sensory localization to D5 spinal level. Digital X-ray revealed no feature suggestive of spinal dysraphism. Contrast magnetic resonance imaging (MRI) characteristics clinched the presumptive diagnosis. Near-total microsurgical excision was done leaving behind a small part of the calcified capsule densely adhered to cord. Histopathological features were confirmative of an epidermoid cyst. Postoperatively, he improved significantly with a gain of motor power sufficient to walk without support within a span of 6 months. Spinal IECs, without any specific clinical presentation, are often diagnosed based upon intraoperative and histopathological findings, however early diagnosis is possible on complete MRI valuation. Complete microsurgical excision, resulting in cessation of clinical progression and remission of symptoms, has to be limited to sub-total or near-total excision if cyst is adherent to cord or its confines.
Collapse
Affiliation(s)
| | | | - Rama Chandra Deo
- Department of Neurosurgery, S. C. B. Medical College, Cuttack, Odisha, India
| | | | | |
Collapse
|
7
|
Gotecha S, Ranade D, Sharma S, Punia P, Kotecha M. Giant intradural intramedullary epidermoid cyst Report of two cases with varied presentations. Asian J Neurosurg 2015; 9:244. [PMID: 25685236 PMCID: PMC4323983 DOI: 10.4103/1793-5482.146653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report two cases with giant intramedullary epidermoid cysts in the thoracolumbosacral and lumbosacral regions with varied presentations. Magnetic resonance (MR) imaging of the thoraco lumbar spine in case 1revealed an intramedullary elongated mass extending from T10 to S2 level causing significant widening of the spinal canal while MR imaging of lumbosacral spine in case 2 showed straightening of the lumbar spine and spina bifida at L5 level with conus at L3 and a lobulated long segment intramedullary solid cystic lesion extending from L2 to S2 veterbrae. The lesion was surgically resected and the pathology revealed an epidermoid cyst. Epidermoid cysts of the spinal cord are rare tumours in the adult population which may be congenital or acquired. Symptoms arising from epidermoid cysts vary with the level of involvement. The treatment of epidermoid cysts is surgical and if possible, complete removal is the goal.
Collapse
Affiliation(s)
- Sarang Gotecha
- Department of Neurosurgery, Padmashree Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India
| | - Deepak Ranade
- Department of Neurosurgery, Padmashree Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India
| | - Shrikant Sharma
- Department of Neurosurgery, Padmashree Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India
| | - Prashant Punia
- Department of Neurosurgery, Padmashree Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India
| | - Megha Kotecha
- Department of Neurosurgery, Padmashree Dr. D. Y. Patil Hospital, Pimpri, Pune, Maharashtra, India
| |
Collapse
|
8
|
Abstract
Spinal dermoid tumors are rare, benign, slow-growing tumors. Rupture of spinal dermoids, in contrast to cranial dermoids, is rarely reported. Rupture in the central canal alone is even more rare, with only a few cases reported in the literature. The presence of fat droplets within the central canal is unusual because the central canal is rudimentary in adults. The authors report 3 such cases and review the pertinent literature.
Collapse
|
9
|
Yin H, Zhang D, Wu Z, Zhou W, Xiao J. Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine. World J Surg Oncol 2014; 12:50. [PMID: 24589060 PMCID: PMC3975861 DOI: 10.1186/1477-7819-12-50] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/19/2014] [Indexed: 12/17/2022] Open
Abstract
Study design This was a retrospective study. Objective The aim of this study was to analyze the clinical characteristics and discuss the treatment options for epidermoid cysts in the lumbar spine. Summary of background data Epidermoid cysts are rare benign neoplasms, which account for less than 1% of all intraspinal tumors. Due to their rarity, there are only a few case reports in the literature. Complete excision is the recommended treatment for an epidermoid cyst, but this is difficult to achieve in the spine. In spite of their benign nature, local recurrence is not uncommon for spinal epidermoid cysts after incomplete excision. Methods Six patients with an epidermoid cyst in the lumbar spine underwent surgical treatment in our center between 2004 and 2011. A total excision using microsurgical techniques and reconstruction was successfully undertaken in all patients. Clinical data and detailed pathologic results were retrospectively analyzed. All cases were followed up for a median time of more than 4 years. The clinical data and surgical efficacy were analyzed to suggest treatment options for epidermoid cysts in the lumbar spine on the basis of a literature review and our own experience. Results The mean age of the patients in this study was 37.7 years and the mean duration of pre-operative symptoms was 29.7 months (2 to 120 months). All patients were disease-free during their follow-up period. Radicular pain nearly disappeared, and patients suffering from neurologic deficits and defecation disorders recovered well. Conclusions Although an epidermoid cyst is a benign tumor, it is apt to recur locally following inadequate removal. Therefore, complete excision with preservation of neural function is an ideal protocol for intraspinal epidermoid cysts. Microsurgical techniques are very useful.
Collapse
Affiliation(s)
| | | | | | - Wang Zhou
- Department of Bone Tumor Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | | |
Collapse
|
10
|
Haber MD, Nguyen DD, Li S. Differentiation of Idiopathic Spinal Cord Herniation from CSF-isointense Intraspinal Extramedullary Lesions Displacing the Cord. Radiographics 2014; 34:313-29. [DOI: 10.1148/rg.342125136] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
11
|
Kumar A, Singh P, Jain P, Badole CM. Intramedullary spinal epidermoid cyst of the cervicodorsal region: A rare entity. J Pediatr Neurosci 2011; 5:49-51. [PMID: 21042510 PMCID: PMC2964782 DOI: 10.4103/1817-1745.66675] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Intramedullary spinal epidermoid cysts are rare, with only few cases having been reported in the literature. We are reporting a case of a 10-year-old female child who presented with symptoms of meningitis with progressive paraparesis. Magnetic resonance imaging of the spine revealed an intramedullary epidermoid cyst from C6 to D5. Near-total excision of the tumor was performed. Histopathological report confirmed the diagnosis of epidermoid cyst. The patient showed progressive recovery.
Collapse
Affiliation(s)
- Ashok Kumar
- Department of Orthopedics and Traumatology, M.G.I.M.S., Sewagram - 442 102 Wardha, Maharashtra, India
| | | | | | | |
Collapse
|
12
|
van Aalst J, Beuls EAM, Cornips EMJ, Vanormelingen L, Vandersteen M, Weber JW, Vles JSH. Anatomy and surgery of the infected dermal sinus of the lower spine. Childs Nerv Syst 2006; 22:1307-15. [PMID: 16708253 DOI: 10.1007/s00381-006-0106-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2005] [Indexed: 10/24/2022]
Abstract
OBJECT Cases of infected dermal sinus are scarce and detailed surgical anatomical descriptions are hardly found in literature. The clinical, radiological, and surgical findings in four cases of an infected dermal sinus located at the lower spine are presented to elucidate the pathological anatomical configuration. CLINICAL MATERIAL The first case showed two dermal sinuses with a parallel course extra- and intradurally, ending in a confluence of cavities connected to the conus. In this case, as well as in the fourth case, the signs and symptoms were those of meningitis. The second case presented with meningitis and a subdural empyema, while the third case presented with an intradermoid-intramedullary abscess at the junction between the DS and the conus. This child probably showed signs and symptoms of conus involvement as early as during pregnancy. CONCLUSION The anatomy of the nervous elements in this congenital anomaly is heavily disturbed, more particularly in case of infection, due to extensive arachnoidal scarring. The latter renders dissection laborious and recognition of anatomical details difficult, resulting in complete excision of a dermal sinus in less than half of the cases. Despite their variability in presentation, most cases of an infected dermal sinus show similar characteristic features.
Collapse
Affiliation(s)
- J van Aalst
- Department of Neurosurgery, University Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
13
|
Davies ESS, Fransson BA, Gavin PR. A Confusing Magnetic Resonance Imaging Observation Complicating Surgery for a Dermoid Cyst in a Rhodesian Ridgeback. Vet Radiol Ultrasound 2004; 45:307-9. [PMID: 15373253 DOI: 10.1111/j.1740-8261.2004.04057.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Emma S S Davies
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, USA.
| | | | | |
Collapse
|
14
|
Karadag D, Karagülle AT, Erden A, Erden I. MR imaging of a ruptured intraspinal dermoid tumour with fat droplets in the central spinal canal. AUSTRALASIAN RADIOLOGY 2002; 46:444-6. [PMID: 12452923 DOI: 10.1046/j.1440-1673.2002.01103.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a patient with intramedullary ruptured spinal dermoid tumour. The MR imaging revealed an intra-medullary lumbar mass heterogenous in intensity in all sequences. Fat droplets were observed in the subarachnoid space as well as in the dilated central spinal canal. Fat droplets in the subarachnoid space are frequently seen in the rupture of intraspinal dermoid tumours; however, fat droplets within the central canal is quite rare and was unexpected. Magnetic resonance imaging is a useful tool in the determination of spinal pathologies before they become large enough to cause severe symptoms and/or morbidity.
Collapse
Affiliation(s)
- Demet Karadag
- University of Ankara, Ibn-i Sina Hospital, Department of Radiology, Sihhiye, Turkey
| | | | | | | |
Collapse
|
15
|
Scarrow AM, Levy EI, Gerszten PC, Kulich SM, Chu CT, Welch WC. Epidermoid cyst of the thoracic spine: case history. Clin Neurol Neurosurg 2001; 103:220-2. [PMID: 11714565 DOI: 10.1016/s0303-8467(01)00156-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Epidermoid cysts of the spinal cord are very rare tumors. We report a 31 year-old female who presented with a 5 months history of progressive lower extremity weakness and spasticity. Magnetic resonance imaging of the thoracic spine revealed a 2 cm intradural, extramedullary mass at the T4-5 level. A T4 and T5 osteoplastic laminotomy with complete removal of the intradural mass was performed. Intraoperative and final histological examination revealed an epidermoid cyst. Epidermoid cysts must be a consideration for intradural, extramedullary lesions of the spinal cord. Complete surgical resection offers the patient an opportunity for good neurologic outcome.
Collapse
Affiliation(s)
- A M Scarrow
- Department of Neurological Surgery, Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Raqbi F, Zérah M, Bodemer C, Lenoir G. [Dermoid cysts revealed by meningitis with medullary compression]. Arch Pediatr 2001; 8:499-503. [PMID: 11396110 DOI: 10.1016/s0929-693x(00)00252-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
UNLABELLED The spinal dermal sinus tracts in the lumbosacral region are not usually recognized, especially when they are not associated with other cutaneous lesions. In these sites, the sinus tracts communicate with the dura in 90% of cases, leading to an important risk of meningitis. CASE REPORTS Two infants (9 and 12 months old) were hospitalized for meningitis. The hospitalization was preceded two weeks earlier by stubborn constipation, which revealed a neural compression. The physical and MRI examination showed a lumbosacral sinus in contact with a dermoid or an epidermoid tumor. These cysts were infected with anaerobic organisms. Despite surgery and antibiotic therapy, one child remained paraplegic. CONCLUSION Dermal sinuses above the intergluteal crease should be surgically excised at the time of diagnosis in all patients, regardless of the patient's age or neurologic findings.
Collapse
Affiliation(s)
- F Raqbi
- Département de pédiatrie, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75345 Paris, France
| | | | | | | |
Collapse
|
17
|
Song JH, Kim MH, Shin KM. Intraspinal epidermoid cyst occurring 15 years after lipomyelomeningocele repair. Case report. J Neurosurg 1999; 90:252-4. [PMID: 10199258 DOI: 10.3171/spi.1999.90.2.0252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a spinal epidermoid cyst that developed in a patient who had undergone surgery for lipomyelomeningocele repair 15 years earlier. The patient presented with symptoms of retethering. Magnetic resonance imaging revealed a cystic intraspinal mass that extended from L-2 to L-5. The mass proved to be an epidermoid cyst. Spinal epidermoid cysts can cause retethering after a repair of lipomyelomeningocele, and the risk of this development can be present for decades.
Collapse
Affiliation(s)
- J H Song
- Department of Neurosurgery, Mokdong Hospital, Ewha Women's University, College of Medicine, Seoul, Korea
| | | | | |
Collapse
|
18
|
Behari S, Banerji D, Gupta RK, Agarwal P, Chhabra DK. Problems in differentiating intradural lipoma from dermoid on magnetic resonance imaging. ACTA ACUST UNITED AC 1997. [DOI: 10.1111/j.1440-1673.1997.tb00630.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|