Spinal Dermoid Research Articles

Non-communicating hydrocephalus decades after spinal dermoid resection

Introduction: We present a case of acute non­ communicating hydrocephalus due to fat droplet obstruction of the cerebral aqueduct, fifty­one years after resection of a spinal dermoid tumor. Case Report: A 71­year­old male presented with sudden onset of neck pain and gait instability. He had prior complete surgical resection of a cervical dermoid cyst in 1959. Follow up magnetic resonance imaging (MRI) in 2007 showed intracranial fat signal droplets within the posterior fossa. An MRI examination obtained in 2012 demonstrated hydrocephalus consequent to fat droplet obstruction at the aqueduct of sylvius which was not present in MRI study done in 2007. Conclusion: To our knowledge there are no published reports of delayed post spinal dermoid resection subarachnoid fat droplet migration leading to acute non­communicating hydrocephalus.

Ruptured Conus Medullaris Dermoid Cyst with Fat Droplets in the Central

Spinal dermoid tumors are rare, benign, slow growing tumors. These tumors may become acutely symptomatic after rupture or infection. Excision of the lesion with long term close follow-up studies is required for the management of these lesions. We present a very rare case of ruptured conus medullaris dermoid cyst in a 22-year-old male presented with urinary retention and low back pain. Magnetic resonance imaging scan with contrast reveals a lesion in the cauda equina inseparable from conus medullaris with fat droplets within the central spinal canal extending up to the medulla. Patient was operated with laminectomy and near complete excision of the lesion was done. Patient's low back pain was relieved following surgery. However patient had persistent urinary incontinence and on clean intermittent self-catheterization. Histopathology was suggestive of dermoid cyst.

Magnetic Resonance Imaging of Ruptured Spinal Dermoid Tumors with Spread of Fatty Droplets in the Central Spinal Canal and/or Spinal Subarachnoidal Space

To evaluate magnetic resonance imaging (MRI) features of ruptured spinal dermoid tumors with spread of lipid droplets in the central spinal canal and/or spinal subarachnoid space and to understand the underlying mechanism. The MRI features of 12-ruptured spinal dermoid tumors were retrospectively analyzed. A literature review was performed to analyze the reported cases of ruptured spinal dermoid tumors along with our cases. The locations of dermoids in our series are all at or below T12 level. Of the 12 cases, 10 ruptured into the central spinal canal, 1 ruptured into the central spinal canal as well as the subarachnoid space, and 1 ruptured into subarachnoid space only. Free lipid droplets exhibited hyperintensity on T1 weighted images, hypointensity on T2 weighted images, and low signal on fat-suppression sequence. Spinal dermoid tumors ruptured into central spinal canal and/or spinal subarachnoid space have unique MRI features. The absorption of lipid droplets within central spinal canal is rather difficult, and their movement is extremely slow. We propose that fatty components within the central canal of spinal cord may be partially associated with spinal dermoid tumors developmentally.

AIRP Best Cases in Radiologic-Pathologic Correlation: Spinal Conus Dermoid Cyst with Lipid Dissemination

History A 67-year-old woman presented with an 18-year history of progressive back pain with lower extremity weakness, which was worse on the left, and bowel and bladder dysfunction. The patient described having no bowel control and urinary incontinence that had required intermittent Foley catheterization during the past year (the year before presentation). The findings from the remainder of the patient’s history were noncontributory. The findings at physical examination did not disclose any cutaneous abnormalities of the back. There was clubbing of the toes of the left foot, with diminished sensation of the sacral dermatomes, decreased vibration sense (pallesthesia) in both feet, and weakness of the left toe flexors and extensors. Ankle reflexes were 1+ bilaterally. The knee jerk reflex was 1+ on the right and 2+ on the left. The findings from cystoscopy and urodynamic testing demonstrated an atonic bladder with marked sensory deprivation.

Ruptured spinal dermoid with central canal and intraventricular extension

Ruptured spinal dermoid with central canal and intraventricular extension

Spinal Dermoid-Epidermoid Lesions

Spinal dermoid-epidermoid lesions constitute less than 1% of all spinal tumors. These lesions are usually congenital and they usually have unique signal characteristics on magnetic resonance imaging. Here we present 5 adult patients with spinal dermoid and epidermoid tumors who had a very long duration of clinical history. It is widely accepted that prudent surgery might avoid neurologic aggravation, but it would bring a high probability of recurrence. Therefore, total surgical extirpation with microsurgical techniques should be preferred. Subtotal excision may be an alternative strategy when the capsule is adherent to adjacent neural structures.

Posterior Fossa Dermoid Cysts in Association with Klippel-Feil Syndrome: Report of Three Cases

Although the association of spinal lumbosacral dysraphism and congenital spinal dermoid tumors is well known, the association of craniocervical spinal anomalies and posterior fossa dermoids has only been recognized recently. Advances in imaging technology and awareness of the association likely contribute to an increase in recently reported cases.

Spinal Sonography in Newborns and Infants - Part II: Spinal Dysraphism and Tethered Cord

Patients with cutaneous markers in the lumbo-sacral region as well as infants with bladder and bowel dysfunction, orthopedic anomalies and progressive neurological dysfunction are at risk for spinal dysraphism and tethered cord. Three types of spinal dysraphism can be distinguished: Type I - open spinal dysraphisms with a non-skin covered back mass; type II - closed spinal dysraphisms with a skin covered back mass; type III - occult spinal dysraphisms without a back mass. All spinal dysraphisms can be associated with a tethered cord, characterized by a low position of the conus medullaris below L3. Type I dysraphisms are meningomyeloceles and myeloceles, which are associated with CHIARI-II malformations characterized by the low position of the cerebellar vermis within the foramen magnum. Type II dysraphisms are lipomyeloceles, lipomyelomeningoceles, posterior meningoceles and myelocystoceles. Lipomeningoceles and lipomyelomeningoceles are characterized by a subcutaneous echogenic mass which communicates with the spinal canal and may cause tethered cord. Posterior meningoceles are, dorsal cystic space occupying lesions without internal neural tissue. Myelocystoceles are characterized by a cystic dorsal mass which communicates with a dilated central canal characteristic of syringo-hydromyelia. Type III dysraphisms without a back mass are frequently associated with cutaneous markers in the lumbo-sacral region. Sonographically dermal sinus tracts, diastematomyelia, tight filum and lipoma of the filum terminale and the caudal regression syndrome have to be distinguished. Dermal sinuses are characterized by an echogenic tract from the skin to the spinal canal, often associated with a spinal dermoid. Diastematomyelia is characterized by a complete or partial duplication of the spinal cord which can only be shown on axial images. Tight filum terminale or lipoma of the filum terminale is characterized by a thick echogenic filum with a diameter of more than 2 mm, and a conus below L3. All different forms of spinal dysraphisms and tethered cord can be diagnosed sonographically in the neonatal period as long as the spinal arches are not completely ossified.

Spinal dermoid presenting with equinovarus deformity of the foot: A Case Report

Spinal dermoid tumors are relatively rare tumors especially in the adult age group. These slow growing benign tumors may become symptomatic at a later age leading to pain and neurological deficits due to involvement of the nerve roots and the cauda equina. We present here a case of a 36-year-old woman who presented with gradually progressive equinovarus deformity of the foot and scoliosis. Magnetic resonance imaging (MRI) revealed a large spinal dermoid tumor at the thoracolumbar junction. CASE REPORT A-36-year-old woman presented for evaluation of gradually progressive equinovarus deformity of the left foot and scoliosis (Fig 1). Figure 1 Figure 1: Equinovarus deformity of the left foot. She first noticed that her left foot was turning inwards about a year ago but at that time did not seek medical attention. There was no history of trauma to the back and she denied any back or leg pain. Neurological examination revealed an equinovarus deformity of left foot and a slightly broad based gait (Video). MRI lumbosacral spine revealed a large dermoid tumor in the spinal canal situated at the thoracolumbar junction (Fig 2). Figure 2 Figure 2: T weighted MRI of the thoracolumbar spine showing a large spinal dermoid with fat content. X-ray of the lumbar spine revealed scoliosis (Fig 3). Surgical excision of the tumor was deferred taking into account the absence of pain or difficulty walking and the possibility of bladder incontinence post surgery. As of this writing she remains in close follow up. Spinal dermoid presenting with equinovarus deformity of the foot: A Case Report 2 of 3 Figure 3 Figure 3: X-ray lumbar spine showing scoliosis. Video: Patient video showing equinovarus deformity of foot while walking. DISCUSSION Dermoid tumors or cysts are not true neoplasms. They along with epidermoid tumors represent inclusion cysts consisting of ectodermal elements 1. They can either be congenital where in during third to fifth week of embryonic development the ectoderm might get entrapped in the neural tube giving rise to epidermoid and dermoid cysts. Trauma has been implicated in the generation of these benign tumors later in life. Rarely skin tissue may be forced into the vertebral canal during lumbar puncture or surgery giving rise to these cystic tumors. Spinal dermoid tumors are most commonly situated near the thoracolumbar junction and may be either intradural intramedullary or intradural extramedullary. Extradural location is the least common for these slow growing tumors. They may involve the conus medullaris and cauda equina leading to back and leg pain as well as weakness. Terai et al reported a case of adult onset tethered cord syndrome due to an intradural dermoid cyst 2. Due to the pain and sensory deficits their patient underwent laminectomy with decompression of the canal and excision of the intradural cyst. We decided to withhold any active neurosurgical intervention in our patient due to the absence of pain or difficulty walking and also taking into consideration the possibility of bladder incontinence post surgery. CORRESPONDENCE TO NK Sethi, MD Department of Neurology NYP-Weill Cornell Medical Center 525 East, 68 Street New York, NY 10021 Email: sethinitinmd@hotmail.com Tel: +646-515-5168

Presumed rupture of a conus medullaris dermoid cyst with cervical intramedullary fat and lipomatous infiltration of the cauda equina

J. Neurosurg: Spine / Volume 5 / August, 2006 Spinal dermoid cysts result from a congenital or acquired inclusion of ectodermic and mesodermic embryonic rests. They can be intramedullary, intradural extramedullary, or extradural lesions. Ruptured dermoid cysts of the lumbar spine in patients without spinal dysraphism are very rare. This 35-year-old man presented with ascending left-foot numbness after golfing. A T1-weighted magnetic resonance (MR) imaging sequence revealed an intramedullary lesion extending from T12 to L-1 and a C1–7 enhancing lesion (Figs. 1 and 2). A syrinx extended to T-11 and subarachnoid fat droplets were present (Fig. 1). Examination of computed tomography findings ruled out the diagnosis of spinal dysraphism. A combined L-1 laminectomy and cordotomy was performed. Pathological examination confirmed the diagnosis of a dermoid cyst. In addition, an intradural extramedullary lipomatous mass involving the cauda equina was found intraoperatively, consistent with a terminal filum lipoma. The patient’s symptoms resolved postoperatively, and MR images at 1 year are unchanged. Symptomatic lumbar spinal dermoid cysts can present as syndromes of the conus medullaris, cauda equina, or as radicular pain. Their rupture can be spontaneous, posttraumatic, or occur following surgery and can cause meningitis, seizures, hydrocephalus, and transient ischemic attacks. Fat droplets have been found in asymptomatic ruptured dermoid cysts located in the central canal in three cases1,2 and in the central cord in one case.2 The intramedullary migration of fat droplets is unexplained and the possible presence of a multifocal dermoid cyst cannot be excluded. A combination of a lipoma and a teratoma of the conus medullaris has been reported4 as well as a dermoid cyst with an intramedullary lipoma.3 In the present case the patient probably had a dermoid cyst with a terminal filum lipoma, which was not visible on MR images. Surgeons should be aware of these combinations because they can affect the surgical plan.

Ruptured spinal dermoid cyst with disseminated intracranial fat droplets

Fat droplets in the cerebrospinal fluid (CSF) is a well-known complication of ruptured intracranial dermoid tumours. We report an unusual case of a ruptured spinal dermoid tumour. MR images showed a tethered spinal cord and an intramedullary fat-containing mass. Fat droplets were revealed in the ventricles and the cisternal spaces on brain CT and brain MR. In the English literature, a ruptured spinal dermoid tumour accompanying a tethered spinal cord is extremely rare.

Hydrocephalus in intraspinal dermoids and dermal sinuses: the spectrum of an uncommon association in children

Hydrocephalus associated with intraspinal tumors constitutes a well-documented occurrence. The accepted mechanisms for this association seem to be well established. On the contrary, hydrocephalus in the context of intraspinal dermoids has been rarely recognized and its pathogenetic mechanism appears to be different. The authors report four pediatric cases of spinal dermoid tumors and dermal sinuses that developed hydrocephalus during the evolution of these congenital lesions of ectodermal origin. In two children, the mechanism leading to the development of hydrocephalus consisted of leptomeningeal inflammation due to bacterial meningitis or to spillage of dermoid cyst contents in the cerebrospinal fluid spaces. We hypothesize that ventricular dilatation in the other two might be the result of chemical meningitis occurring during intrauterine life. Two cases developed ventriculomegaly prior to the diagnosis of their spinal cord disease. The unusual evolution of these cases suggests that neuroimaging studies that include the spine should be performed in cases of childhood "unexplained hydrocephalus".

Dermoid cyst with dermal sinus tract complicated with spinal subdural abscess

Spinal subdural abscess caused by spread of infection with the dermal sinus tract is rare in children. This article reports on a 1-year-old male with prolonged fever, progressive paraplegia, and bowel and bladder dysfunction resulting from a spinal subdural abscess secondary to an infected spinal dermoid cyst with a dermal sinus tract. This is the youngest patient to be reported having this condition. Surgical intervention was performed to find a tumor that had capsule and keratinlike contents. Culture of the abscess was positive for Escherichia coli and Bacteroides vulgatus. He received 6 weeks of parenteral antibiotic treatment. This patient illustrates the importance of urgent radiologic examination, immediate surgical resection, and appropriate antibiotic therapy for spinal subdural abscess.

Spinal dermoid cysts originating intracranial fat drops causing obstructive hydrocephalus: Case reports

The authors report two cases of spinal dermoid cysts whose rupture originated the migration of free fat drops into the ventricles and intracranial subarachnoid spaces. In both cases the fat drops caused obstructive hydrocephalus, which represents a quite exceptional complication. Moreover, one of the cases is unique, since the finding of intracranial fat causing hydrocephalus considerably preceded the discovery of the spinal neoplasm. The authors suggest that the finding of intracranial fat in the absence of a local source makes the search for a intraspinal dermoid or epidermoid tumor mandatory.

Ruptured spinal dermoid cyst with chemical arachnoiditis and disseminated intracranial lipid droplets

A 33-year-old man presented with a 3-month history of gradually progressive leg weakness. Spinal MRI and myelography with CT demonstrated an extensive intradural abnormality suggesting a diffuse inflammatory or neoplastic process. Only after cranial CT and MRI demonstrated lipid droplets was the diagnosis of a ruptured spinal dermoid cyst suggested. Subsequent laminectomy revealed a ruptured intradural dermoid cyst in the lumbar spine, with chemical arachnoiditis.

Ruptured spinal dermoid cyst with chemical arachnoiditis and disseminated intracranial lipid droplets

Ruptured spinal dermoid cyst with chemical arachnoiditis and disseminated intracranial lipid droplets

Spinal dermoid cyst manifesting with acute urinary retention: CT and MR imaging findings

Spinal dermoid cyst manifesting with acute urinary retention: CT and MR imaging findings

Long-term results of the surgical treatment of spinal dermoid and epidermoid tumors.

The clinical findings and the results of surgical treatment in 16 patients with spinal dermoid or epidermoid tumors are reported. In 9 patients the tumor capsule adhered so tightly to the nervous tissue that part of it was left in situ. In a follow-up study ranging from 5 to 30 years with a mean of 14.2 years only 1 patient had a recurrence of the tumor and 10 patients resumed a normal working life.

Long-Term Results of the Surgical Treatment of Spinal Dermoid and Epidermoid Tumors.

Abstract The clinical findings and the results of surgical treatment in 16 patients with spinal dermoid or epidermoid tumors are reported. In 9 patients the tumor capsule adhered so tightly to the nervous tissue that part of it was left in situ. In a follow-up study ranging from 5 to 30 years with a mean of 14.2 years only 1 patient had a recurrence of the tumor and 10 patients resumed a normal working life.

Spinal Dermoid Cyst: Characteristic CT Findings after Metrizamide Myelography

A 25-year-old male complained of intermittent, sharp pains about the left eye and in the left side of the chest. Neurological examination revealed paresthesia and impaired perception of touch and pin-pricks in the dermatomes of Th8 and Th9 on the left side. In all four extremities, the muscle stretch reflexes were equal and slightly hyperactive, without weakness or sensory deficits. Metrizamide myelography showed defective filling at the level between the upper 8th and 9th thoracic vertebrae. The lesion was also demonstrated by computed tomography (CT) scan performed 1 hour later, appearing as an oval, radiolucent mass in the left dorsal spinal canal, which compressed the spinal cord forward and toward the right. Serial sections of the spinal canal revealed the lesion to be partly filled with contrast medium. Repeat CT scan 24 hours after metrizamide myelography showed more contrast medium in the periphery of the lesion, giving it a doughnut-shaped appearance. At surgery a smooth-surfaced cyst containing sebum and white hair was totally removed from the intradural extramedullary space. The histological diagnosis was dermoid cyst. There have been a few reported cases of intracranial epidermoid cyst in which filling of the cyst was suggested on metrizamide CT myelography. These findings may complicate the differential diagnosis of arachnoid cyst and dermoid or epidermoid cyst when only CT is used.