Intraspinal dermoid and epidermoid cysts: Long-term outcome and risk factors

Intramedullary Spinal Epidermoid Cyst-A Rare Cause of Spastic Paraparesis

Spinal intramedullary epidermoids are rare intramedullary lesions of the spinal cord. They may be congenital or acquired with the congenital type often associated with spinal dysraphism and other spinal anomalies. The clinical presentation depends on the level of the involvement of the spinal cord. Management of these lesions is surgical excision. We report a case of intramedullary spinal epidermoid who presented with spastic paraparesis.

Co-existent epidermoid and dermoid in a child with spinal dysraphism

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Giant Epidermoid Cyst of Posterior Fossa-Our Experience and Literature Review

Introduction. Intracranial epidermoid cysts are the most frequent congenital intracranial lesion. They rare and benign tumors that can present in different clinical situations depending on location and extension of the disease. Diagnosis is obtained with radiological imaging with RM and non-enhanced TC as elective investigating methods. Elective treatment is surgery, based on total/subtotal excision sparring healthy neurovascular structures, considering the benign nature of this lesion. Case Report. In this study we present the case of a 79-year-old woman affected by recidivist epidermal cyst of the posterior fossa. Clinical presentation was characterized by positional subjective vertigo, intense headache localized in the right part of the head increased by Valsalva maneuver and retroarticular subcutaneous swelling. Radiological investigation found a giant epidemoid cyst of the posterior fossa (8,4 x 4,8 x 5,8 cm), treated with surgery. In the postoperative, the patient was fine and no neurological deficit has been encounterd. REVIEW. In this study, we present a review of the literature regarding giant epidermoid cysts of posterior fossa. Only 11 cases were reported before ours, which actually is one of the largest ever described.