Intramedullary Epidermoid Cyst Research Articles

Dorsal Dermal Sinus with Intramedullary Epidermoid Cyst in a Toddler: A Tiny Clue to Underlying Major Neurological Condition

Background: Skin dimples at specific sites of the body at birth are a clue to underlying congenital malformation and intimate the need for extensive evaluation. A midline dimple in the spinal region may be a sign of occult spinal dysraphism in a neonate. Methods: A toddler presented with clinical symptoms and signs of acute paraparesis. The child also had thoracic dermal sinus on clinical examination. The child was evaluated with hematological and radiological investigations to diagnose the cause of acute paraparesis. Results: Hematological investigations were normal. Magnetic resonance imaging of the spine showed an intramedullary epidermoid cyst at the D1 vertebral level to D4 vertebral level with dorsal dermal sinus at the D3 vertebral level. Conclusion: We are reporting this case to insist on clinical examination of all neonates for skin dimples and detailed evaluation of neonates with suspicious skin dimples to prevent future neurological disability. A clinically significant skin dimple implies impending neurological problems in a patient.

Treatment of cervicodorsalepidermiod cyst

Intramedullary spinal epidermoid cysts are rare, with only few cases having been reported in the literature. A case of a eighteen months-old male child who presented with chronic progressive qaudriparesis and urine incontinance . Magnetic resonance imaging of the spine revealed an intramedullary epidermoid cyst at cervicomedullary at level c2-c3. Near-total excision of the tumor was performed. Histopathological report confirmed the diagnosis of epidermoid cyst. The patient showed progressive recovery.

Lumbar Intradural Intramedullary Epidermoid Cyst: A Case Report

Epidermoid cysts have a benign etiology and can be either congenital, usually associated with malformations, or acquired, related to external events, and even iatrogenic. As for their location, they are classified as extradural, intradural, extramedullary, and intramedullary. Intradural intramedullary epidermoid cysts are quite uncommon, with few cases reported in literature so far. Because of its slow growth, there may be a delay in diagnosis. Its symptoms depend on lesion’s topography, and total cyst removal is recommended to improve the condition. In this paper, we report the case of an adult patient with progressive spastic crural paraparesis, without associated malformations. Imaging exams showed an intradural intramedullary epidermoid cyst, which was completely removed, with subsequent improvement of patient’s clinical status.

A Rare Case of Intramedullary Epidermoid Cyst at Conus with the Review of Literature

Summary: 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. Keywords: Epidermoid cyst, Spine, Intramedullary, Conus Medullaris, Magnetic resonance imaging.

下位胸椎脊髄髄内類表皮のう胞とretained medullary cordを併発した小児の1例

下位胸椎脊髄髄内類表皮のう胞とretained medullary cordを併発した小児の1例

A Rare Case of Infected Cervicodorsal Intramedullary Epidermoid Cyst

Abstract Introduction Intramedullary spinal epidermoid cysts have a reported incidence of less than 1% of intramedullary spinal cord tumors; and out of these, intramedullary epidermoid lesions within the cervical spinal cord are even rarer. Here, we present the case of an adult patient with an infected intramedullary epidermoid cyst, identified on magnetic resonance imaging (MRI) at the C7–D1 level that was successfully excised without any worsening of neurological status. Case Presentation A 23-year-old female patient presented with history of moderate degree intermittent fever followed by gradually progressive right-sided weakness. She had paresthesia below C5 dermatome on the right side. On close inspection of the back, a tiny sinus opening was noted at the D2 level near the midline. MRI of the spine showed an intramedullary lesion at the C6–D1 level with the tract connecting to the subcutaneous lesion. Somatosensory evoked potential (SSEP) monitoring was done during the surgery with near total excision of the lesion. Conclusion Even though the location is rare, a differential diagnosis of the epidermoid should always be considered. A tiny dermal sinus opening helped us in proper diagnosis, along with surgical excision, by providing us a direct path to the intramedullary lesion. An early diagnosis and treatment with neurophysiological monitoring helped us in the maximum safe resection of the lesion without developing any new deficit.

Recurrent intramedullary epidermoid cyst of spinal cord: A rare entity

Epidermoid cysts of the spinal cord without spinal dysraphisms are rare lesions and intramedullary cysts are still rarer. Approximately only over 60 cases are reported in literature worldwide. Magnetic resonance imaging is the imaging modality of choice for the diagnosis of these lesions. Management of these lesions is by total surgical excision, although at times, it is not possible due to adherence of the capsule to the parenchyma of the spinal cord which may be the cause of recurrence. To our knowledge, this is the second case of recurrent intramedullary epidermoid cyst of spinal cord. We report a case of intramedullary epidermoid cyst which recurred after 7 years following near-total excision of tumor at our institute.

Surgical Resection of a Recurrent Intramedullary Spinal Epidermoid Cyst: 2-Dimensional Operative Video.

Intramedullary spinal epidermoid cysts are rare tumors and only account for 1% of all spinal tumors in adults. Epidermoid cysts can develop from ectodermal tissue that was inappropriately positioned in the primitive neural tube during closure; acquired forms exist for epidermoid cysts as they can emerge in an iatrogenic manner following repeated lumbar punctures. Malignant progression of epidermoid cysts is extremely rare, and symptoms typically depend on tumor location. Surgical resection is the preferred treatment. Gross total resection is ideal; however, partial resections have demonstrated satisfactory long-term outcomes. We present a 54-yr-old man with symptomatic recurrence of thoracic intramedullary epidermoid cyst after two prior resections (25 yr and 11 yr ago, respectively). The patient noted worsening back pain, leg spasticity and weakness. Magnetic resonance imaging (MRI) of the thoracic spine demonstrated interval expansion of the upper thoracic intramedullary epidermoid cyst compared to surveillance MRI from 3 yr prior. Given the progressive nature of symptoms, the patient elected to have surgical resection of the tumor. This operative video highlights the technique and surgical nuances of gross-total resection of a recurrent thoracic intramedullary spinal epidermoid cyst. This patient was noted to have a stable neurological exam at the 6-mo follow-up visit with planned adjuvant radiation treatment. There is no identifying information in this video. Patient consent was obtained for publishing of the material included in the video.

Intramedullary epidermoid cysts in adults: Case report and updated literature review

Epidermoid cysts are classical tumors in neurosurgery, but spinal locations are rare and intramedullary locations represent only approximately 80 cases in the literature. Intramedullary epidermoid cysts arise from ectodermic tissue inclusion during neural tube closure. Intramedullary epidermoid cysts are more frequent in young patients and in a thoracic location. We report the case of a 61-year-old patient consulting for bilateral asymmetrical progressive paraparesis and proprioceptive ataxia revealing a T3–T4 exophytic medullar epidermoid cyst. The tumor was surgically removed with a favorable outcome. The capsule was partially removed. The authors present an updated literature review of intramedullary epidermoid cyst diagnosis, management and recommendations.

Dorsal Intramedullary Epidermoid Cyst: Report of Two Rare Cases and Review of Literature

Study Design A report on two rare cases of dorsal intramedullary spinal epidermoid cyst. Objective Clinical presentation, diagnosis, and surgical outcome of the two cases are discussed. Case Description We report two cases of dorsal intramedullary epidermoid cyst, both presenting with descending spastic upper motor neuron type of paraparesis with pain and paresthesia of the lower limbs and early involvement of bladder and bowel. Magnetic resonance imaging was done to come to a diagnosis where the first case was having a dorsal intramedullary epidermoid cyst at D6–D7 and the second case has an epidermoid cyst at D5–D6 intravertebral level. Results Near-total excision of the tumor was done in both the patients under microscope. Histopathologic examination confirmed the tumor as epidermoid. There was gradual neurologic improvement in both the cases on follow-up. Conclusion Cases presenting with dorsal myelopathy without spinal dysraphism may be due to rare causes such as epidermoid cyst, and near-total excision of such cyst with microneurosurgical technique can give a good outcome.

Type II diastematomyelia with intramedullary epidermoid cyst : An expected but rare association.

Diastematomyelia is rare congenital anomaly most often seen in lumbar region .Epidermoid tumors in spinal canal are rarer, more so in the intramedullary location. While the pathogenesis of diastematomyelia has been explained in classical papers and can explain the cooccurrence of epidermoid tumors in these cases, the actual reported cases as such are quite rare. The author reports clinical, radiological and operative findings of such a case.

Malignant transformation of an intramedullary epidermoid cyst in the thoracic region of the spinal cord

Malignant transformation of epidermoid cysts (ECs) to squamous cell carcinomas (SCCs) in the CNS is exceedingly rare and has only been described in intracranial ECs. In this article, the authors describe a 53-year-old man with a history of a previously resected T3-4 EC, who presented with a 2-month history of progressively worsening weakness in the left side of his body. Magnetic resonance imaging revealed an enhancing mass in the T3-4 region, the exact location of the previous cyst. The mass was resected in gross-total fashion, and pathological analysis revealed an SCC. Postoperatively, the patient regained full strength in his lower extremities. After the resection, he received radiotherapy administered at an isodose of 50 Gy. To the authors' knowledge, this is the first reported case of malignant transformation of an intramedullary spinal EC in the literature.

Thoracic intramedullary spinal epidermoid tumor: A rare entity

Epidermoid cyst in the spinal cord is a rare condition. It constitutes of only 0.6-1.1% of all spinal tumors. We are reporting a case of a 22-year-old female who presented with complaints of tingling and numbness in both lower limbs since past 3 years and weakness in both lower limbs since past 1 year, which gradually progressed. Since last 3 months she was unable to walk and get up from their squatting position. Magnetic resonance imaging of spine revealed a mid-thoracic intramedullary mass with obliteration of anterior and posterior subarachnoid space, which was confirmed as an intramedullary epidermoid cyst at surgery. Total excision of intramedullary epidermoid tumor was performed. Histopathological examination of resected specimen confirmed the diagnosis of epidermoid cyst. The patient recovered progressively after initial deterioration in neurological status.

Diffusion-Weighted Magnetic Resonance Imaging of an Intramedullary Epidermoid Cyst with Dorsal Dermal Sinus Tract in a Toddler

We report the use of diffusion-weighted magnetic resonance imaging to diagnose and manage a rare case of a symptomatic thoracic intramedullary congenital epidermoid cyst with associated dermal sinus in a girl. Congenital intramedullary epidermoid cysts with associated dermal sinuses are very rare occurrences and seldom present symptomatically in very young children. We present a case of a 32-month old with a draining dimpled skin lesion. Magnetic resonance images demonstrated an intramedullary epidermoid with a dorsal dermal sinus tract opening to the skin surface which was confirmed surgically. The patient was treated with debulking to prevent recurrent infection and progression of neurological symptoms. This case demonstrates the use of diffuse-weighted MRI to assist in the diagnosis and surgical management of an atypical presentation of a rare developmental abnormality, which is not well documented in the pediatric radiological literature. Failure to diagnosis may have significant neurological permanent debilitating consequences.

Clinical evolution of primary intramedullary tumors in adults

Objectives. The objectives of our clinical study are the evaluation of preoperatory myelic involvement and postoperative follow up, establishing in the mean time the interval and capacity of recovery for adults with primary intramedullary tumors. Material and method. Between January 2001 and December 2008, 14 adult patients diagnosed with intramedullary tumors representing 20,6% of all primary spinal tumors treated in Targu-Mures Neurosurgery Clinic, were studied. The majority of intramedullary tumors were represented by ependymomas (64.3%), followed in equal numbers by astrocytomas and hemangioblastomas (14.3% each) and a rare case of intramedullary epidermoid cyst. Each sign and symptom was monitored with the help of a grading scale going from 5 (asymptomatic patient) to 0 (paraplegia, total absence of functional capacity). Additionally, for monitoring the functional capacity outcome we used the Karnofsky score. The resulted quantitative data of our study was analysed using the T-student test. Results. The major signs of debut were spinal back pain (50%) and motor deficit (35%). The interval between disease debut and diagnostic was variable scaling from one month to 15 years with an average of 28.8 months ± 45.4 months. The clinical status was towards progressive neurological deterioration. At the diagnostic moment all patients presented motor deficit, 12 of them (86%) presented walking disorders, 64% presented sensory deficit and only 12% presented sphincter disturbances. Postoperative evolution was characterized by a transitory neurological deterioration in 57% of cases, the deterioration being recovered during the first 3 months in 75% of cases, in 25% of cases the neurological recovery to preoperatory status extended during a period of 6 months postoperatively. Beyond the interval of 3 months postoperatively, the neurological status was stationary. The main result of surgical intervention was maintenance of preoperative neurological status. Conclusions. The clinical evolution of primary intramedullary tumors in adults was towards progressive neurological deterioration and severe myelic involvement. The surgical intervention maintains rather than improves the preoperative neurological status thus early diagnosis and treatment of this pathology represent the major favorable prognostic factors.

Scoliosis With Concurrent Thoracic Diastematomyelia, Syrinx, and Intradural Intramedullary Epidermoid Cyst

The aim of this paper is to report the first presentation of type 2 thoracic diastematomyelia with concurrent syrinx, intradural intramedullary epidermoid cyst, and scoliosis, in which scoliosis correction was performed. The incidence of intraspinal anomalies in patients with congenital spinal deformity varies from 4.9% to 58% depending on the reports by the authors and diagnostic techniques. Most of these are tethered cord, diastematomyelia, and syringomyelia. Intramedullary epidermoid cysts of the spinal cord are very rare tumors, especially those associated with spinal dysraphism. Clinical manifestations of these anomalies may be absent at first; therefore, MRI is important at initial evaluation. Intervention for intraspinal anomaly and scoliosis correction can be performed separately or together as 1 procedure. A 12-year-old girl was brought to us because of progressive spinal deformity. The patient had a right thoracic curve at T5-T12 of 31 degrees. The curve was rigid and partial fusion at T6-T8 was noted. MRI of the spinal cord was taken to detect any neural axis abnormalities, and it revealed diastematomyelia at T5-T8 levels and adjacent syringomyelia superiorly. Neurological examination was normal. The patient underwent syrinx drainage and diastematomyelia resection together with scoliosis correction in 1 surgical procedure. A white-gray–colored tissue of 1 cm diameter and well-defined borders was detected in the syrinx cavity, and it was excised. There were no intraoperative or postoperative complications. The patient began ambulating on postoperative day 2. Postoperative Cobb angle was 5 degrees and the pathologic diagnosis of the lesion was an epidermoid cyst.

An Extensive Intramedullary Epidermoid Cyst with a Longstanding History of Paraplegia: A Case Report

Spinal cord tumors still challenge clinicians because of their neurological deterioration before and after surgery. Epidermoid cyst is one of the rare intramedullary lesions producing neurological deterioration in cervical spine and it has been reported four times in the literature. We report the case of an intramedullary epidermoid cyst showing a longstanding history of paraplegia as well as recent slowly progressive tingling paresthesia extending from C4 to T10 and weakness in both hands.

Intramedullary Epidermoid Cyst in the Thoracic Spine of a Dog

A 5 yr old female spayed mastiff was evaluated for a 3-4 mo history of paraparesis and 3 days of acutely worse paraparesis and incontinence. On magnetic resonance imaging, a spinal cord lesion was present at the ninth thoracic vertebra. The lesion was hyperintense on T2-weighted images (T2-W), and a hyperintense rim was present on T1-weighted postcontrast images. Histologic examination showed a cystic mass lined by squamous epithelial cells. Histopathologic diagnosis was an intramedullary epidermoid spinal cyst. Epidermoid cyst should be a differential diagnosis in young dogs with a myelopathy and an intramedullary spinal cord lesion on magnetic resonance imaging examination.

Cervical Intramedullary Epidermoid Cyst with Liquid Contents

Intramedullary spinal epidermoid cysts are benign ectopic embryological growths with reported incidence of less than 1% of intramedullary tumors. In this case we report an unusual cervical intramedullary epidermid with liquid contents. A 40-year-old patient presented with progressive weakness of all four limbs of four months duration, bowel and bladder disturbances of two days duration, pain and paresthesias in all four limbs. Magnetic resonance imaging (MRI) revealed a well defined intramedullary lesion extending from C2-C3 level with widening of the cord. The lesion was hypointense on T1W images, hyperintense on T2W and fluid attenuation and inversion recovery images with thin rim of enhancement after contrast administration. Histopathological examination of the excised specimen revealed epidermal lining and keratinous material features of an epidermoid cyst. As in present case, rarely epidermoid cyst can have clear contents, and an MRI finding can closely mimic the features of arachnoid cyst, findings not classical and is different than described in literature.

Intramedullary spinal epidermoid cyst of the cervicodorsal region: A rare entity

Intramedullary spinal epidermoid cysts are rare, with only few cases having been reported in the literature. We are reporting a case of a 10-year-old female child who presented with symptoms of meningitis with progressive paraparesis. Magnetic resonance imaging of the spine revealed an intramedullary epidermoid cyst from C6 to D5. Near-total excision of the tumor was performed. Histopathological report confirmed the diagnosis of epidermoid cyst. The patient showed progressive recovery.