Intraspinal epidermoid cyst occurring 15 years after lipomyelomeningocele repair. Case report

Lumbar Intramedullary Epidermoid Following Repair of Sacral Myelomeningocele and Tethered Cord: A Case Report With a Review of the Relevant Literature and Operative Nuances

Epidermoid cysts of the spine are rare tumors. While the majority of them occur spontaneously, in very few cases, they can occur following previous surgery for spinal dysraphism. Such tumors tend to occur at the site of previous surgery. The occurrence of an epidermoid cyst at a level higher than the previous surgical site is a rare entity. We present a rare case of a lumbar intramedullary and extramedullary epidermoid occurring at a level higher than the previous surgical site, along with a discussion of the causes of such an occurrence and operative nuances regarding the management of an intramedullary epidermoid in a pediatric patient.

Spinal extradural inclusion dermoid cyst mimicking pseudomeningocele, appearing after 17 years of meningomyelocele repair

Dermoid cysts are congenital cystic tumors arising from embryonic rests and commonest site is in the thoracic region of the spinal canal. The authors reported a case of dermoid cyst in a 17-year-old boy appearing after lumbar meningomyelocele repair at 2 months of age. The boy presented with 6 months history of gradually progressive globular swelling at the site of previous scar and weakness of the left foot. Preoperatively small extradurally protruding placode was seen attached to the swelling. The swelling was completely excised. At 1 year follow-up patient had improvement in foot weakness with magnetic resonance imaging showing no residual or recurrent lesion.

Epidermoid cysts associated with thoracic meningocele

Intraspinal tumours of cutaneous origin associated with various spinal dysraphisms have been well documented in the literature. However, the metachronous development of intra- and extra-medullary tumours in conjunction with dorsal meningocele is rare. The authors report a patient with a thoracic dorsal meningocele and congenital intradural extramedullary epidermoid tumour. The patient developed an intramedullary epidermoid growth 12 years later. Subtotal resection of the tumour predisposed to a later recurrence. Meningocele is not always an isolated clinical entity but the concurrent occult lesions are usually veiled by the more conspicuous surface anomaly. Thorough magnetic resonance imaging of the whole neural axis helps to identify associated pathologies. Delicate intradural exploration by a microsurgical approach is necessary to achieve appropriate treatment.