Cauda Equina Syndrome in an Eleven-Month-Old Infant Following Sacrococcygeal Teratoma Tumor Resection and Coccyx Excision

Abstract

A case report of cauda equina syndrome (CES) in an 11-month-old infant, following sacrococcygeal teratoma tumor resection and coccyx excision leading to a spinal epidural hematoma (SEH). To illustrate a rare case of CES and SEH in an infant, and discuss the need for sealing access to the spinal canal after sacrococcygeal surgical resection and reconstruction. To the authors' knowledge, this is the youngest patient reported to develop a SEH and CES, and the only patient reported in the literature to develop a SEH after coccyx excision. Seventeen days after undergoing sacrococcygeal tumor resection and coccyx excision, the patient presented to the emergency room with a large distended bladder, loss of rectal tone, and significant weakness in the lower extremities. Magnetic resonance imaging of the thoracic and lumbar spine showed a large lesion in the dorsal epidural space extending from T12 to the tip of the communicating with the prior operative site by means of the previous coccyx resection. The infant was emergently brought to the operating room for decompression. The patient was discharged 6 days later with diminished neurologic function, but demonstrated significant improvement over the next 18 months and currently remains disease free and neurologically normal at age 7. This case demonstrates the need for future examination of sacrococcygeal surgical resection and subsequent reconstruction of excised structures to decrease the risk of communication with the epidural space.