Intraspinal Epidermoid Tumors Research Articles

Impact of Location on Resectability and Neurological Outcome in Spinal Cutaneous Inclusion Tumors

Background: Spinal cutaneous inclusion tumors are extremely rare, accounting for less than 1% of intraspinal tumors. The existing literature is scarce; in last two decades, only eight case series have documented more than 10 patients. We tried to figure out if intramedullary and extramedullary locations have an impact on outcomes in terms of extent of resection and neurological recovery. Materials and Methods: A retrospective review of intraspinal epidermoid and dermoid tumors operated at our Neurosurgical Department, between May 2006 and May 2021, was made. McCormick grading was used to evaluate the neurological status of all patients at presentation, after surgery, and at the follow-up visit in the outpatient clinic. The neurological status at the last follow-up was taken as final. Results: Of 15 cases, eight (53.3%) were males with the age at presentation ranging from 7 to 60 years (mean = 24.4 years). Spinal dysraphism was associated in four patients. The proportion of region involved in descending order was lumbar (46.6%), thoracic/thoracolumbar/lumbosacral (13.3% each) and cervicothoracic/sacrococcygeal (6.6% each) with 11 gross total resections (73.3%) and four subtotal resections (all intramedullary). Two-tailed Fischer’s exact test showed a significant correlation between location, extent of resection, and neurological recovery, whereas histological subtype and region had no significant impact on the outcome. Conclusions: To the best of our knowledge, this is the eighth largest study in the last two decades, reporting 15 cases with long-term follow-up. We attempt to bring clarity to the notion of location having no effect on resectablity by specifying location in terms of spinal compartment involved and describing spinal level as region. Overall, our gross total resection rate was lower (73.3%) than other contemporary studies (86.6%–92%), but a subgroup analysis with regard to the location of tumor revealed the intramedullary location to be the primary determinant of the extent of resection.

Intraspinal dermoid and epidermoid cysts: Long-term outcome and risk factors

Objective: The literature on long-term outcome after resection of intraspinal dermoid and epidermoid tumors is limited. The purpose of this study was to review the progression-free survival (PFS), overall survival (OS), and long-term outcome in a consecutive series of 57 patients with intraspinal dermoid and epidermoid tumors. Design: Retrospective study. Methods: A total of 57 patients who underwent surgery at our institution between 2002 and 2010 were reviewed. Patients outcome were determined using the Japanese Orthopaedic Association score (JOA) and the McCormick score. Results: The follow-up data were 100% complete and the median follow-up time was 9.2 years. Gross total resection was performed in 21 patients (36.84%) and subtotal resection in 36 patients (63.16%). The PFS and OS at 8 years were 78.95% and 100% respectively. A good outcome was observed in 56.14% of patients based on the JOA and McCormick score. The univariate analysis showed that a tumor size of more than 4 cm, subtotal resection and sphincter disturbances were the influencing factors of poor outcome. Conclusion: The gold standard treatment for intraspinal tumors is gross total resection, but the operation needs to protect the remaining nerve function as much as possible and follow-up should be focused on patients with a high risk of poor outcome.

There is High Incidence of Skin Cells in the First and Third Drops of Cerebrospinal Fluid in Spinal Anesthesia

Background and objectivesSkin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia. MethodsSamples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. ResultsSquamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p=0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p=0.257). ConclusionsHigh percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel,

There is High Incidence of Skin Cells in the First and Third Drops of Cerebrospinal Fluid in Spinal Anesthesia

Background and objectives: Skin fragments during lumbar punctures may develop intraspinal epidermoid tumors. The aim of this study was to determine the incidence of epithelial cells that reflow along with the first and third drops of CSF of patients undergoing spinal anesthesia. Methods: Samples of the first and third drops of cerebrospinal fluid were collected from 39 adult patients undergoing spinal anesthesia with a 25G Quincke needle. Four microscope slides were prepared: one for the first drop, one for third drop, one for the needle, and one with a drop of saline for control. A pathologist examined the slides randomly. Results: Squamous epithelial cells were identified in 35 (89.7%) samples from the first drop, 34 (87.2%) from the third drop, and 24 (61.5%) from spinal needle. The third drop showed a mean number of cells larger than the first drop (p = 0.046). Nucleated epithelial cells were found in a sample of the first drop (2.56%), in four samples of third drop (10.25%), and in one spinal needle (2.56%). Third drop showed a mean number of nucleated cells higher than first drop with no statistical difference (p = 0.257). Conclusions: High percentage of epithelial cells was found in the first (89.7%) and third (87.2%) drops of CSF reflow and in used needles (61.5%). Skin cells were found even using small gauge disposable needles with well-adapted mandrel

Iatrogenic Epidermoid Tumor: Late Complication of Lumbar Puncture

Intraspinal epidermoid tumors can be congenital and acquired. Acquired intraspinal epidermoid tumors are extremely rare. Epidermal elements are implanted into the arachnoid space by trauma, spinal anesthesia, surgery, bullet wounds, myelography, or lumbar puncture. Approximately 40% of acquired epidermoid tumors are considered a late complication of lumbar puncture. The authors report the case of an 8-year-old boy who presented with a 1-year history of back and hip pain and radiating pain to both thighs posterior. Lumbar puncture was performed in the neonatal intensive care unit to rule out meningitis in the patient's past medical history. The patient underwent total surgical excision of the epidermoid tumor. Pathologic examination revealed the diagnosis of epidermoid tumor. intraspinal epidermoid tumor; lumbar puncture; children.

Cauda equina syndrome due to implantation epidermoid tumor: After 38 years of surgery for lumbar meningocele in a neonate

Intraspinal epidermoid tumors are rare. Most of these tumors occur spontaneously, while others may be acquired. Occurrence of epidermoid tumor following surgery for spinal dysraphism has been reported till 15 years from the day of surgery. We report here a case of Cauda equina syndrome due to intraspinal epidermoid tumor following 38 years of surgery for spinal dysraphism. Though epidermoid tumors grow linearly - unlike other tumors, which grow exponentially - we could not find any report in English literature where such a long time of 38 years was taken for the tumor to manifest clinically. The longest period reported for epidermoid tumors to manifest clinically following repair of spinal dysraphism is 15 years. We report this case because it is a case of the longest silent period taken by the implantation epidermoid tumor to manifest clinically.

Primary lumbar epidermoid tumor mimicking schwannoma

A case of a primary lumbar epidermoid tumor is described. Intraspinal epidermoid tumors are rare. The differential diagnosis on this case was a nerve sheath tumor, such as aschwannoma, as the tumor entered the dural sac and caused dural ectasia. The diagnostic pitfalls of this feature of the tumor are discussed.

Intraspinal Epidermoid Tumors in Children

Iatrogenic intraspinal epidermoid tumors are very rare. The similarity of the clinical manifestations of the tumor with other childhood problems can pose a problem in diagnosis. In addition, because of the lag in time between the lumbar puncture and the development of a symptomatic tumor, this relationship is overlooked and can cause a delay in diagnosis, as in the present report of four children. Magnetic resonance imaging was found to be superior to myelography in defining the tumor and its relationship to other structures inside the dural sac. All patients underwent surgical excision, with subsequent resolution of symptoms.

Intraspinal Epidermoid Tumors in Children

Summary: Iatrogenic intraspinal epidermoid tumors are very rare. The similarity of the clinical manifestations of the tumor with other childhood problems can pose a problem in diagnosis. In addition, because of the lag in time between the lumbar puncture and the development of a symptomatic tumor, this relationship is overlooked and can cause a delay in diagnosis, as in the present report of four children. Magnetic resonance imaging was found to be superior to myelography in defining the tumor and its relationship to other structures inside the dural sac. All patients underwent surgical excision, with subsequent resolution of symptoms.

Intramedullary Epidermoid Cyst Evaluated by Computed Tomographic Scan and Magnetic Resonance Imaging: Case Report

Abstract The authors have treated a 20-year-old man with a dorsal intramedullary epidermoid cyst in whom magnetic resonance imaging was performed both before evacuation of the cyst and 3 months later. Intraspinal epidermoid tumors are rare, and the intramedullary location is quite uncommon. To our knowledge, this is the first description of magnetic resonance imaging of an intramedullary epidermoid cyst. The frequency, possibilities, and limits of surgical treatment of such intraspinal benign tumors are reviewed.

Intraspinal Epidermoid Tumors Caused by Lumbar Puncture

It is well known that congenital intraspinal epidermoid tumors, while rare, do occur. That they may also be related to spinal puncture is less well understood. In the present article, four such cases are described, including one in which an earlier myelogram performed because of lumbar disk disease showed that no tumor was present prior to the spinal puncture. The pertinent literature is reviewed, and the probable mechanism of formation of such tumors and the means for avoiding it are discussed.

Iatrogenic intraspinal epidermoid tumors : S. Batnitzky, T. R. Keucher, J. Mealey, Jr., and R. L. Campbell. JAMA 237:148–150 (January), 1977

Iatrogenic intraspinal epidermoid tumors : S. Batnitzky, T. R. Keucher, J. Mealey, Jr., and R. L. Campbell. JAMA 237:148–150 (January), 1977

Iatrogenic Intraspinal Epidermoid Tumors

Intraspinal epidermoid tumors may be congenital or acquired in origin. Lumbar punctures performed with needles without stylets or with ill-fitting stylets are responsible for the implantation of epidermal fragments into the spinal canal and the resultant iatrogenic intraspinal epidermoid tumors. Pain in the back or lower extremities is a striking clinical feature in these cases. Myelography should be considered for every patient who has pain in the lower extremities or back and who has had previous lumbar punctures.

Iatrogenic intraspinal epidermoid tumors

Iatrogenic intraspinal epidermoid tumors

Intraspinal epidermoid tumor.

Intraspinal epidermoid tumors usually arise as a congenital inclusion of epithelial tissue, but can result from poor lumbar puncture technic. Failure to diagnose these tumors promptly often delays or misdirects treatment, as shown in the case presented here. A myelogram often is required for diagnosis since abnormalities may not be visible on a plain film.

Intramedullary epidermoid tumors of the thoracic spinal cord. Report of two cases.

E PIDERMOID tumors involving the spinal cord are quite rare. 4,'~,8,~',11,1:* The opinion of the majority of authors is that these tumors arise from displaced normallydeveloping somatic cells. Recently, Van Gilder and Schwartz TM reported a method of producing epidermoid and dermoid tumors in the albino rat by direct skin implantation along the neuraxis; this evidence supports the concepts of a congenital origin or subsequent development after repeated lumbar puncture. The vast majority of intraspinal epidermoid tumors are intradural and extramedullary. They are commonly associated with a dermal sinus and occur usually in the lumbosacral segments. In 1962, Manno, et al.fl in a review of all reported cases, found only five tumors that they classified as being intramedullary. However, a critical review of these cases 4-3,~~ revealed that these were confined to the conus medullaris and extended down the dural sac; hence, they were not truly intramedullary. Gross 6 reported a case in which the tumor initially appeared intradurally and upon reoperation years later was found within the substance of the cord. King, 7 in 1957, reported a case quite similar to the ones we are about to describe and stated that he was unable to locate a similar case in the literature. In none of these series has a long-term follow-up been reported giving the results of operative management of a recurrent tumor or the effect of radiotherapy upon such a lesion. We are able to provide these data in the following cases.