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Nitheesha Reddy V, Nagarajan K, Midhusha Reddy V, Amuthabharathi M, Gopalakrishnan MS, Ramesh AS. Spectrum of intracranial and spinal epidermoids including unusual locations and imaging findings: A pictorial review. J Med Imaging Radiat Oncol 2023; 67:65-76. [PMID: 36468221 DOI: 10.1111/1754-9485.13495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 11/15/2022] [Indexed: 12/09/2022]
Abstract
Intracranial and spinal epidermoids are benign slow-growing congenital lesions. They are predominantly intradural, extra-axial in location, with intra-axial locations (intra-parenchymal and spinal intramedullary) being rare. The most common locations of intradural epidermoids are cerebellopontine angle cistern followed by supra- and para-sellar regions, and fourth ventricle. Less common locations include inter-hemispheric fissure, sylvian fissure, lateral ventricle, intracerebral, velum interpositum cistern, superior cerebellar cistern and pineal gland. They can also be extradural, usually arising in the diploic space of the calvaria, though they are less common. Magnetic resonance imaging is the primary modality for diagnosis and knowing the extent of the lesion. In this pictorial review, we intend to illustrate their classical and unusual locations, atypical imaging findings including calcifications, rare complications like haemorrhage or spontaneous rupture.
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Affiliation(s)
- Vendoti Nitheesha Reddy
- Departments of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Krishnan Nagarajan
- Departments of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Vendoti Midhusha Reddy
- Departments of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Mohan Amuthabharathi
- Departments of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Madhavan S Gopalakrishnan
- Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
| | - Andi S Ramesh
- Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Pondicherry, India
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Maurya VP, Singh Y, Srivastava AK, Das KK, Bhaisora KS, Sardhara J, Behari S. Spinal Dermoid and Epidermoid Cyst: An Institutional Experience and Clinical Insight into the Neural Tube Closure Models. J Neurosci Rural Pract 2021; 12:495-503. [PMID: 34295103 PMCID: PMC8289537 DOI: 10.1055/s-0041-1724229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives
The spinal dermoid and epidermoid cysts (SDECs) are rare entities comprising less than 1% of pediatric intraspinal tumors. The present study aims to extrapolate the clinicoradiological data, in order to identify the most plausible neural tube closure model in human and provide a retrospective representation from our clinical experience.
Materials and Methods
We collected the details of all histologically proven, newly diagnosed primary SDECs who underwent excision over the past 20 years. Secondary or recurrent lesions and other spinal cord tumors were excluded. Surgical and follow-up details of these patients as well as those with associated spinal dysraphism were reviewed. Clinical and radiological follow-up revealed the recurrence in these inborn spinal cord disorders.
Results
A total of 73 patients were included retrospectively, having a mean age of 22.4 ± 13.3 years, and 41 (56.2%) cases fell in the first two decades of life. Twenty-four (32.9%) dermoid and 49 (67.1%) epidermoid cysts comprised the study population and 20 of them had associated spinal dysraphism. The distribution of SDECs was the most common in lumbosacral region (
n
= 30) which was 10 times more common than in the sacral region (
n
= 3). Bladder dysfunction 50 (68.5%) and pain 48 (65.7%) were the most common presenting complaints. During follow-up visits, 40/48 (83.3%) cases showed sensory improvement while 11/16 (68.7%) regained normal bowel function. There was no surgical mortality with recurrence seen in eight till the last follow-up.
Conclusions
The protracted clinical course of the spinal inclusion cysts mandates a long-term follow-up. The results of our study support the multisite closure model and attempt to provide a retrospective reflection of neural tube closure model in humans by using SDECs as the surrogate marker of neural tube closure defect.
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Affiliation(s)
- Ved P Maurya
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yashveer Singh
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arun K Srivastava
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kuntal K Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Kamlesh S Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Wang J, Li D, Yang R, Tang X, Yan T, Guo W. Epidemiological characteristics of 1385 primary sacral tumors in one institution in China. World J Surg Oncol 2020; 18:297. [PMID: 33183334 PMCID: PMC7664043 DOI: 10.1186/s12957-020-02045-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/05/2020] [Indexed: 12/20/2022] Open
Abstract
Background Sacral tumors and tumor-like lesions are a rare group of lesions that can affect children and adults of all ages. Little is known about clinical characteristics of age, gender, histologic type, and anatomic site in China. Methods A total of 1385 patients with sacral tumors and tumor-like lesions, which had the clinical record at our bone tumor center from January 2000 to November 2018 were analyzed. The metastatic cancers were not included in the present study. Results A total of 51.7% (716 cases) were malignant and 48.3% (669 cases) were benign tumors or tumor-like lesions. Of malignant tumors, chordoma was the most common malignant tumor (316 cases, 22.8% of all tumors), followed by chondrosarcoma, myeloma, and other histologic types. The most common histological type of benign tumors was a giant cell tumor accounting for 14.8% (205 cases) of all tumors, followed by neurofibroma, schwannoma, and other types. The most common age group affected by malignant bone tumors was the 51- to 60-year-old group, followed by the 41- to 50-year-old group. The most commonly affected age group for benign tumors and tumor-like lesions was the 31- to 50-year-old group, followed by the 21- to 30-year old group. Furthermore, the following histologic types had gender predilection. Chordoma, chondrosarcoma, myeloma, and osteosarcoma affected more frequently males than females. Malignant peripheral nerve sheath tumor, lymphoma, giant cell tumor, neurofibroma, tuberculosis, teratoma, and epidermoid cyst more frequently affected females than males. Conclusions The large cohort of sacral tumors and tumor-like lesions in our database may reveal their clinical characteristics of age, gender, histologic type, and anatomic site in China and features of sacral tumors and tumor-like lesions are fairly distinct from the mobile spine and extremities.
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Affiliation(s)
- Jun Wang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Dasen Li
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Rongli Yang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Xiaodong Tang
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Taiqiang Yan
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People's Hospital, No. 11 Xizhimen South Street, Beijing, 100044, China.
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Sîrbu OM, Chirteş AV, Mitricã M, Sîrbu CA. Spinal Intramedullary Epidermoid Cyst: Case Report and Updated Literature Review. World Neurosurg 2020; 139:39-50. [DOI: 10.1016/j.wneu.2020.03.207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/17/2022]
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Rahimizadeh A, Sharifi G. Spinal intramedullary epidermoid cysts: Three case presentations and literature review. Surg Neurol Int 2020; 11:17. [PMID: 32123605 PMCID: PMC7049888 DOI: 10.25259/sni_540_2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/14/2019] [Indexed: 12/03/2022] Open
Abstract
Background: True intramedullary epidermoid cysts (IECs) not associated with congenital anomalies or previous spinal procedures are extremely rare. In a review of the literature since 1992, only 29 such cases have been reported. Here, we add three new cases in this category. Case Description: Three adults presented with spastic paraparesis attributed to thoracic IECs. Gross total microsurgical removal was achieved in two cases, while one case was a partial resection due to capsular adherence to the cord. In all three cases, patients sustained complete recoveries of neurological function and remained symptom free for an average of 5 years follow-up. Conclusion: IECs are rare lesions; here, the three located in the thoracic spine, contributed to slow, progressive spastic paraparesis with/without incontinence, and resolved following total (2 patients) and partial (1 patient) resection.
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Affiliation(s)
- Abolfazl Rahimizadeh
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Guive Sharifi
- Department of Neurosurgery, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Hao D, Zhu J, Wang X, Chang Z. A Case of Scheuermann’s Disease Co-Occurrence with Idiopathic Scoliosis and Intradural-Extramedullary Epidermoid Cyst: The First Case Report in Literature. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background and importance: Scheuermann’s disease (SD), intradural-extramedullary epidermoid cysts and idiopathic scoliosis (IS) are all rare conditions. The co-occurrence of the three condition on one case has not been reported in literature before. We describe an extremely rare case of SD co-occurrence with IS and intradural-extramedullary epidermoid cyst, which is the first in the literature.
Clinical presentation: A 13-year old boy and his parents presented at Honghui Hospital complaining of progressive hyperkyphosis for 5 years and back pain for 2 months. Thorough medical examination and radiology confirmed the diagnosis of SD kyphosis, IS, and intradural-extramedullary epidermoid cyst. Medical panel with spine surgeons, oncologists, neurosurgeons, histopathologists and radiologists were consulted. Tumor excise, kyphosis recorrection and spine reconstruction surgery was conducted. Postoperative histological examination detected desquamation of keratin from the epithelial lining and stratified squamous epithelium without skin adnexa. The boy was ambulant 2 days postoperative with walking aids.
Conclusion: This is the first case report of Scheuermann’s disease (SD) co-occurrence with idiopathic scoliosis (IS) and intradural-extramedullary epidermoid cyst. The co-occurrence of intradural epidermoid cyst, SD and IS might not be a coincidence, indicating a kind of genetic etiology need to be illuminated.
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Maeda T, Mishima K, Imanishi J, Shirahata M, Suzuki T, Adachi JI, Sasaki A, Nishikawa R. An Epidermoid Cyst of the Thoracic Spine in an Elderly Patient. World Neurosurg 2019; 127:113-116. [PMID: 30951916 DOI: 10.1016/j.wneu.2019.03.262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spinal epidermoid cysts are very rare tumors, especially in the thoracic spine; they represent 0.8% of all spinal epidermoids. In adult cases, they are often associated with surgical procedures such as lumbar puncture. We report a rare case of spinal epidermoid cyst in the thoracic spine of an elderly patient who had never undergone lumber puncture, thoracic spinal surgery, or trauma. CASE DESCRIPTION A 78-year old woman presented with a 1-month history of rapidly progressive impairment of sensation in both the lower limbs, with gait disturbance. She had no history of spinal surgery, trauma, or lumbar puncture. Her past medical history was unremarkable. Magnetic resonance imaging of the whole spine revealed an intraspinalextramedullary tumor at the Th 1-2 level. Diffusion-weighted imaging revealed significant homogeneous high intensity. We performed complete resection without damaging the spinal cord or nerve roots. The final histological examination indicated epidermoid cyst without malignancy. Her gait disturbance was completely resolved at 4-month follow-up. CONCLUSIONS Epidermoid cysts must be considered among spinal tumors in elderly patients. Early detection by diffusion-weighted imaging and complete resection may lead to good neurological outcome.
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Affiliation(s)
- Takuma Maeda
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
| | - Kazuhiko Mishima
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Jungo Imanishi
- Department of Orthopaedic Oncology and Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Jun-Ichi Adachi
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Moroyama, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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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]
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9
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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.
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Affiliation(s)
| | | | - Rama Chandra Deo
- Department of Neurosurgery, S. C. B. Medical College, Cuttack, Odisha, India
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Liu H, Zhang JN, Zhu T. Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region. J Clin Neurosci 2012; 19:712-7. [PMID: 22436108 DOI: 10.1016/j.jocn.2011.07.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 06/27/2011] [Accepted: 07/03/2011] [Indexed: 11/24/2022]
Abstract
The aim of this study was to evaluate the characteristics and surgical outcome of spinal epidermoid and dermoid cysts in the lumbosacral spine. We reviewed 26 patients with spinal epidermoid and dermoid cysts (15 epidermoid and 11 dermoid) treated between October 2000 and December 2010. The latter 15 patients of this series underwent neurophysiological monitoring during surgery. Gross total resection of the tumour was achieved in 46.2% of patients, and 53.8% underwent subtotal resection. In 14 patients, the tumour capsule adhered so tightly to the neural structures that a section of the capsule remained in situ. After surgery, the Japanese Orthopaedic Association score improved in 80.8% of patients, remained stable in 15.4%, and declined in 3.8%. The average follow-up period was 53 months. Three patients developed recurrence of the tumour and 20 patients resumed a normal working life. Microsurgical techniques and intraoperative neurophysiological monitoring are practical and reliable methods for radical removal of spinal epidermoid and dermoid cysts that involve the conus medullaris and cauda equina.
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Affiliation(s)
- Hui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 An-Shan Road, Tianjin 300052, China
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Nica DA, Strambu VED, Roşca T, Cioti D, Copaciu R, Stroi M, Ciurea AV, Popa F. Acquired epidermoid cysts of the cauda equina. J Med Life 2011; 4:305-9. [PMID: 22567058 PMCID: PMC3168827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/25/2011] [Indexed: 11/18/2022] Open
Abstract
Intradural extramedullary epidermoid (EC) cysts are uncommon (0.2-1%). Acquired tumors appear more frequently as a late complication of lumbar punctures (40%). The authors present three cases of epidermoid cysts of the cauda equina which were surgically treated in their department during the past five years. All three had suffered lumbar punctures for rachianesthesia 6-9 years prior to their presentation. The patients' ages ranged between 19 and 31. Surgical treatment was deemed necessary because of the space-occupying nature of this slow-growing lesion, and this indication was supported by the MRI findings. Two-level laminectomy and microsurgical total tumor ablation were performed in all three cases. There were no postoperative complications.
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Affiliation(s)
- DA Nica
- Neurosurgery Clinic, ‘Sf. Pantelimon’ Emergency Hospital, BucharestRomania
| | - VED Strambu
- Surgery Clinic, ‘Sf. Pantelimon’ Emergency Hospital, BucharestRomania
| | - T Roşca
- Neurosurgery Clinic, ‘Sf. Pantelimon’ Emergency Hospital, BucharestRomania
| | - D Cioti
- Neurosurgery Clinic, ‘Sf. Pantelimon’ Emergency Hospital, BucharestRomania
| | - R Copaciu
- Neurosurgery Clinic, ‘Sf. Pantelimon’ Emergency Hospital, BucharestRomania
| | - M Stroi
- Institute of Cerebro–Vascular Diseases and Microsurgery, BucharestRomania
| | - AV Ciurea
- First Clinic Neurosurgery, ‘Bagdasar–Arseni’ Emergency Hospital, BucharestRomania
| | - F Popa
- Surgery Clinic, ‘Sf. Pantelimon’ Emergency Hospital, BucharestRomania
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