Elderly onset intramedullary epidermoid cyst in the conus medullaris: a case report (original) (raw)
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Spinal intramedullary epidermoid cysts: Three case presentations and literature review
Surgical Neurology International, 2020
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.
Intramedullary epidermoid cyst of spinal cord: Experience of 24 Cases at a Tertiary Care Institute
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Epidermoid cyst is the sequel of developmental aberration often intriguing the neurosurgeons. Intramedullary epidermoid cysts are rare entities with delay and variability in the clinical presentation. The aim of present study is to analyze clinical presentation and management issues of this entity of neurological pertinence. Materials and Method: The study is retrospective analysis of cases operated for intramedullary epidermoid cysts of spinal cord at King Edward Memorial Hospital, Mumbai over a period of 16 years from 2001 to 2016. All relevant hospital records and follow-up were analyzed. Results: The study revealed that this entity more commonly manifests in males of second and third decades. The age at the time of presentation ranged from 3 to 51 years (mean age-24.2 years). There were 15 male and 9 female patients. The average duration of complaints was 7 months. The backache and stiffness of both lower limbs were most common presentations followed by sphincter disturbances and dysaesthesia. Our follow up ranged from a period of 6 months to 15 years with a mean of 9.6 years. Patients had excellent clinical recovery with safe excision of cyst contents with recurrence in three patients. Conclusions: Our study highlights that patients of intramedullary epidermoids have satisfactory outcome with safe resection of cyst content leaving behind the densely adherent capsule.
Spinal Intramedullary Epidermoid Cyst: Case Report and Updated Literature Review
World Neurosurgery, 2020
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Epidermoid Intramedullary Cyst: A Rare Case Report
Journal of Medical Cases
Epidermoid cysts are tumors that ocur in most parts of the body and are often treated by neurosurgeons, but intramedullary localizations of epidermoid cysts are very rare. The incidence in adults is lower than 1% and in children lower than 3%.We report a case of a 27-year-old patient presenting with thoracic spinal cord compression syndrome (T11-12). The magnetic resonance imaging (MRI) showed an intramedullary cystic mass. It demonstrated low signal intensity on T1-weighted sequence and high signal intensity on T2-weighted sequences, with minimal peripheral enhancement following intravenous administration of gadoteric acid. After surgical removal of the tumor, the pathology confirmed the radiological diagnosis of spinal epidermoid cyst. MRI reduces the delay in diagnosis of spinal cord tumors but should be guided by clinical judgment.
Intramedullary Epidermoid Cyst of the Conus Medullaris: A Case Report and Literature Review
International Medical Case Reports Journal
Background: Central nervous system tumors are usually located in the brain, and spinal cord tumors account for approximately 20% of central nervous system tumors. Epidermoid cysts constitute <1% of all intraspinal tumors. It consists of squamous epithelial-lined cysts containing keratin, cholesterol, and cellular granules. Epidermoid cysts can be classified as congenital, acquired, extradural, extramedullary, or intramedullary according to etiology and location. The intradural intramedullary type is uncommon. Case Presentation: An 11-year-old female patient had back pain with radiation to both lower extremities but worsened on the left side for 5 years. On neurological examination, motor strength was 3/5 for hip flexion and knee extension bilaterally and 5/5 for other key muscle groups. Contrast-enhanced lumbosacral magnetic resonance imaging (MRI) revealed T1 hypointense and T2 hyperintense lesions in the L2-L4 intramedullary conus and cauda equina. Laminectomy and near total resection were done, and histopathological examination revealed an epidermoid cyst. On the third postoperative day, the patient was discharged with completely resolved back pain and an improvement in lower extremity motor power. At monthly follow-up visits for a further 6 months, her back pain and weakness completely resolved, and she had no neurologic deficits. A postoperative lumbosacral MRI was done and confirmed near total excision of the tumor. Conclusion: Intramedullary conus epidermoid cysts are rare but not unknown to neurosurgeons. MRI with diffusion-weighted images (DWI) is an imaging modality of choice. Asymptomatic patients can be conservatively treated. Once the patient has progressive symptoms and signs of compression, surgical excision is recommended. Meticulous electrocauterization may help decrease tumor regrowth in the remnant capsule, which is recommended. Avoiding leakage of cyst fluid into the subarachnoid space helps to avoid postoperative chemical meningitis. Radiotherapy is an option for the management of multiple recurrences.
Intramedullary spinal epidermoid cyst of the upper thoracic region
Journal of Clinical Neuroscience, 2009
We report a 40-year-old male who presented with a two year history of thoracic cord compression. MRI of the thoracic spine demonstrated a diffuse, non-gadolinium enhancing intramedullary spinal cord tumour, extending from the C7 to T2 vertebral body levels. The lesion was surgically resected and the pathology revealed an epidermoid cyst. Epidermoid cysts are rare slow-growing lesions apparently resulting from inclusion of ectodermal tissue during the closure of the neural tube. The average age of presentation
Iranian journal of neurosurgery, 2018
Background and Importance: Epidermoid cyst in the spinal cord is a rare condition. It constitutes of only 0.6-1.1% of all spinal tumors. When they occur, the typical location is in the subdural, extramedullary space of the lumbo-sacral region. Case Presentation: We report a forty-two-year-old female who presented with left extremity radicular pain and myelopathy. MRI of the thoracic spine,illustrated a focal fusiform enlargement of the thoracic cord at T4 and T5. Histopathological examination confirmed the diagnosis of epidermoid cyst. Conclusion: The lesion was surgically resected and the pathology revealed we discuss the clinical features, MR imaging characteristics and surgical findings of this rare tumor and review the associated literature.
A Rare Case of Intramedullary Epidermoid Cyst at Conus with the Review of Literature
https://www.ijrrjournal.com/IJRR\_Vol.9\_Issue.2\_Feb2022/IJRR-Abstract023.html, 2022
We present a case of young male who presented with history of gradually progressive low backache and bladder incontinence. Clinically he was diagnosed as a case of cauda-conus syndrome. Imaging revealed an intramedullary cystic lesion at conus medullaris with features favoring epidermoid cyst. The diagnosis was confirmed on histopathological examination.
Thoracic Spinal Intradural Intramedullary Epidermoid Cyst: Case Report
Egyptian Spine Journal, 2017
Background Data: Epidermoid cysts grow slowly so the symptoms would present with slowly progressive course and delay in the diagnosis that may extend up to years. 4 Presence of neurological symptoms and signs is usually detected that might be associated with local mild but persistent back pain. Purpose: To describe a case presentation of spinal epidermoid cyst. Study design: A case report of intradural thoracic an epidermoid cyst. Patients and Methods: Our case was a forty years old male patient presenting with left lower limb motor weakness. He had a 5 month history of slowly progressive left lower limb weakness and not associated with sphincter disturbance. Magnetic resonance imaging of the spine demonstrated an intradural lesion of the thoracic part of the spinal cord. Results: The lesion was excised totally and 14 days after the surgical removal, the motor power of the left lower limb showed marked improvement up to grade 4 on MRC scale. Conclusion: The diagnosis of intradural epidermoid cyst could be considered in patients with slowly progressive lower limbs weakness and mild persistent back pain. (2016ESJ121)