Cervical intramedullary epidermoid cyst with liquid contents

Spinal intramedullary epidermoid cysts: Three case presentations and literature review

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.

Elderly onset intramedullary epidermoid cyst in the conus medullaris: a case report

INTRODUCTION

Epidermoid cysts are known as embryonic or acquired ectopic aberrations of the ectoderm. To the best of our knowledge, there are only a few reports of elderly onset intramedullary epidermoid cysts. We report a case of elderly onset intramedullary epidermoid cyst at the conus medullaris.

CASE PRESENTATION

A 63-year-old Japanese woman working as a farmer presented with slowly progressive gait disturbance and voiding dysfunction. A magnetic resonance imaging scan revealed an intramedullary mass lesion at L1 to L3. We diagnosed the lesion as an intramedullary spinal cord tumor. A laminectomy was performed at the level of Th12 to L3. Upon spinal cord dissection, a yellowish milky exudation erupted from the cystic lesion. We resected white cartilage-like pieces from the cystic cavity. Because the wall of the cystic lesion tightly adhered to the spinal cord parenchyma, we abandoned complete resection of the cyst wall. The pathological diagnosis was an epidermoid cyst.

CONCLUSIONS

We propose that evacuation of the cyst contents is preferable, especially in cases with elderly onset and congenital origin.

Intramedullary arachnoid cyst in association with cervical spondylosis: case report

BACKGROUND CONTEXT

Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently.

PURPOSE

Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis.

STUDY DESIGN

To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis.

METHODS

Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity.

RESULT

Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status.

CONCLUSION

Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation.

Atypical features of a midline pre-pontine epidermoid cyst

Intracranial epidermoid cysts are uncommon lesions with typical radiological and operative findings. We report a midline cystic lesion in the pre-pontine cistern, with radiological features of an epidermoid, but intra-operatively yielding a thin-walled cyst with fluid contents. The cyst wall showed stratified squamous epithelium on histopathology.

Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region

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.