Direct visualization of spinal dermoid cyst by positive contrast study.

Abstract

The purpose of this presentation is to report a case of an extensive spinal dermoid cyst in which definite diagnosis and extent of the lesion were determined prior to surgery by the accidental puncture of the cyst on an attempted spinal tap for myelography with the injection of contrast medium into the cyst cavity. Discussion of possible complications will follow the case presentation. This 26-year-old male was admitted with the chief complaint of low back pain, unsteady gait, and difficulty urinating of four weeks' duration. The past history revealed the presence of a pilonidal abscess in the sacral region which had periodically drained and had been excised three months earlier. Physical examination revealed tenderness over the lumbo-sacral region. Some weakness of both lower extremities was present, together with markedly hyperactive tendon reflexes. Babinski's sign was positive bilaterally. A well-healed scar was noted over the lower sacral region in the mid-line. Blood pressure was 150/80, and the pulse rate 84 per minute. Plain radiographs of the spine revealed minimal widening of the interpedicular spaces from L2 to L5. On the lateral view, the posterior margins of the bodies of L2 to S3 showed evidence of erosion, more prominent in the sacral region. To avoid puncturing an intraspinal mass, it was decided to attempt a spinal tap at T12–L1 level. Thick, yellowish, white cheesy material was aspirated.