Spinal Epidermoid Cyst Research Articles

An unusual late complication of peridural anesthesia: The case of a subdural spinal epidermoid cyst: A case report and literature review

The peridural approach is primarily used today to provide analgesia in obstetrics and postoperative care. Peridural analgesia is not only more effective than systemic analgesia, but it also has benefits in terms of morbidity, particularly regarding postoperative respiratory complications and the shortened duration of postoperative ileus. Unlike dural tears, immediate and severe neurological complications such as hematomas or abscesses are very rare. Long-term sequelae are less well known because the relationship with epidural analgesia performed several months or years earlier is not always well established. We report a rare case of a 35-year-old patient with a history of epidural anesthesia five years ago during childbirth, who was admitted with cauda equina syndrome. MRI (magnetic resonance imaging) of the lumbar spine showed a subdural lesion at the level of L3. The patient underwent resection of the lesion, and the pathological examination of the surgical specimen concluded it was an epidermoid cyst.

Intradural extramedullary epidermoid cyst: Case report

Spinal epidermoid cysts are benign tumors. They are most commonly extramedullary intradural tumors. Intramedullary localization is the exception. In this review, we report the case of a 45-year-old patient with a dorsal intradural extramedullary epidermoid cyst, revealed by dorsal spinal pain and right lower limb weakness, we discuss the clinical aspects, radiological features, and neurosurgical treatment.

Isolated thoracic intradural extramedullary epidermoid cyst: A technical note.

Congenital, acquired, and iatrogenic spinal epidermoid cysts (EC) are very rare. A 62-year-old female patient presented with a 5-month history of progressive paraparesis leading to paraplegia secondary to a posterior compressive intradural extramedullary lesion at the T7 level. The patient underwent a laminectomy/durotomy for gross total tumor excision. Histopathology confirmed the lesion was an epidermoid cyst. Although her spasticity improved within 5 weeks, she only regained partial lower extremity motion (i.e., 3/5 motor function). Patients presenting with the acute/subacute onset of paraparesis secondary to spinal EC should undergo timely gross total cyst resections to optimize neurological outcomes.

Spinal Intradural Epidermoid Cyst with Dermal Sinus in a 2 – Year Old Child: A Rare Case Report

Introduction: Spinal epidermoid accounts for < 1% of all primary cord tumor. This rare benign lesion may be congenital or acquired. Invagination of epidermal elements into the neural tube during embryonic period leads to the development of epidermoid cyst. Case Presentation: A 2 year old girl presented with a spontaneous intergluteal swelling with dermal sinus and lower limbs weakness. The lumber MR demonstrated an intradural lesion from L3 to L5 levels that compressed cauda equine or nerve roots. MR findings were compatible with an epidermoid cyst with dermal sinus without any coexistent spinal dysraphism. The patient underwent microsurgical laminectomy from L3 to L5, tumor was resected and sent for histopathological examination. A pearly white tumor was found and histopathology revealed an epidermoid tumor. Post-operative Magnetic Resonance Imaging (MRI) finding was total removal. Conclusion: Diagnosis of spinal epidermoid cyst is often delayed due to its obscure presentation. Here, we presented spinal lumber intradural epidermoid cyst with dermal sinus which was treated successfully with microsurgical total resection with preservation of spinal stability and neurological function. Post-operative follow up with MRI is helpful.

Pediatric Dorsal Intradural Extra-Medullary Epidermoid Cyst (Non-Dysraphic): An Illustrative Case with Literature Review

A spinal epidermoid cyst is a rare congenital tumour that may be associated with spinal dysraphism. Congenital spinal epidermoid cysts without spinal dysraphism are rare. Here we are reporting a rare and interesting case of thoracic Intradural extra-medullary epidermoid cyst not associated with spinal dysraphism. Epidermoid cysts (EC) represent less than 1.0% and are rarely seen as an intradural extra-medullary spinal cord tumor. Preoperative Clinico- Radiological assumption is important for surgical planning. Journal of National Institute of Neurosciences Bangladesh, January 2023;9(1):88-95

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.

EXTRAMEDULLARY EPIDERMOID IN A CASE OF MYELOMENINGOCOELE: AN UNUSUAL ASSOCIATION

Spinal epidermoid cysts are rare constituting between 0.5% to 1% of all spinal tumors but accounting for up to 10% of intraspinal tumors in children. They are most often seen in the lumbosacral spine. Males are more frequently affected than females. Epidermoid cysts arise from pathologic displacement of epidermal cells into the spinal canal. They can be acquired from trauma, lumbar puncture, surgery such as myelomeningocele closure or arise as congenital lesions, like when there is improper closure of the neural tube, which results in the inclusion of epiblasts in the neural tube. Forty percent are intramedullary and sixty percent are extramedullary. Myelomeningocele is an entity which is common in the lumbosacral region due to congenital neurulation defect. The prevalence of myelomeningocele is approximately 0.8 to 1 per 1000 live births worldwide. The anatomical location may vary as cases of cervical, cervicothoracic, thoracic, thoracolumbar, lumbar and sacral have also been documented. The sac usually contains nerve bres or neural tissues, however sometimes it may contain intradural lipoma or dermoids. Here we present a rare case of a 1 year 6 month old male child presenting with with dorsolumbar myelomeningocele with symptoms of urinary and bowel incontinence and weakness of both lower limbs found to have extrameduallary epidermoid as a content of myelomeningocoele sac. The concurrence of a congenintal neoplasm within the spinal canal associated with myelomeningocele seems to be a very rare event as very few such cases have been reported worldwide to the best of our knowledge

Imaging findings in cranial and spinal epidermoid cysts

Intrakranielle Epidermoidzysten sind angeboren und entstehen bereits in der dritten bis fünften Gestationswoche beim Verschluss des Neuralrohres. Sie stammen von ektopischen ektodermalen Zellen ab, die irrtümlicherweise in der neuralen Rille verblieben sind.

Isolated extramedullary intradural thoracic epidermoid cyst: A rare case report

Spinal epidermoid cyst is a rare entity. It may be congenital with associated spinal dysraphism such asspina bifida ,dermal sinus tract and other neural tube defects or acquired due to repeated lumbar puncture and trauma. Congenital spinal epidermoid cysts without spinal dysraphism are rare. Here we are reporting a rare and interesting case of thoracic extramedullary intradural epidermoid cyst with no associated features of spinal dysraphism or history of iatrogenic trauma in a young male patient.

Microsurgery for intradural epidermoid cyst at cauda equina level in a 9-year-old child: A case report.

Introduction and importanceEpidermoid cysts are rare benign tumors. Here, we present a case of spontaneous intradural epidermoid cyst at cauda equina level in a 9-year-old patient, which we believed the first case to be reported in Vietnam.Case presentationA 9-year-old boy presented with 4 months of spontaneous left lower extremity muscle weakness and paresthesia. The MRI images suggested the diagnosis of intradural epidermoid cyst at cauda equina level. The patient underwent L5–S1 laminectomy and durotomy for tumor resection. The histology confirmed the diagnosis of epidermoid cyst. Post-operative images demonstrated total cyst removal.Clinical discussionThe epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed.ConclusionDiagnosis of spinal epidermoid cyst is often delayed for its obscure presentation. Microsurgical dissection along with intra-operative mobile C-Arms enable total tumor resection while preserving spinal stability and neurological function. Follow-up with post-operative magnetic resonance imaging and tumor marker are helpful.

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.

Post-traumatic Sacral Epidermoid Cyst Masquerading as Chordoma on Imaging: A Case Report

Intradural spinal epidermoid cysts are rare, benign lesions either acquired from trauma, surgery, lumbar puncture or arise as congenital lesions, particularly associated with spinal dysraphism. Epidermoid cyst arising from the spine with expansile destruction of vertebrae has not been reported yet in the literature. We report a case of 36-years male presented with history of fall 8 years back with progressive symptoms of lower back pain, weakness of left lower limb and bladder/bowel incontinence. Computed tomography revealed large lytic expansile, midline sacral vertebral lesion with soft tissue component and multiple calcific foci. Magnetic resonance imaging demonstrated large non-enhancing heterogeneous mass showing restricted diffusion on diffusion weighted images. The patient underwent biopsy confirming the diagnosis of an epidermoid cyst. The possibility of an epidermoid tumor should be kept in the differential diagnosis in patients presenting with post-traumatic sacral mass.

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.

Epidermoid Intramedullary Cyst: A Rare Case Report

Epidermoid cysts are tumors that ocur in most parts of the body and are often treated by neurosurgeons, but intramedullary localizations of epidermoid cysts are very rare. The incidence in adults is lower than 1% and in children lower than 3%.We report a case of a 27-year-old patient presenting with thoracic spinal cord compression syndrome (T11-12). The magnetic resonance imaging (MRI) showed an intramedullary cystic mass. It demonstrated low signal intensity on T1-weighted sequence and high signal intensity on T2-weighted sequences, with minimal peripheral enhancement following intravenous administration of gadoteric acid. After surgical removal of the tumor, the pathology confirmed the radiological diagnosis of spinal epidermoid cyst. MRI reduces the delay in diagnosis of spinal cord tumors but should be guided by clinical judgment. J Med Cases. 2019;10(3):67-71 doi: https://doi.org/10.14740/jmc3224

Spinal cord epidermoid cysts

the study aim was to comprehensively investigate the epidemiological and clinical peculiarities of spinal cord epidermoid cysts and evaluate immediate and long-term results of their surgical treatment. We describe and analyze surgical outcomes of 20 patients with spinal cord epidermoid cysts. This sample was selected from 554 patients with intramedullary tumors and 365 patients with spinal dysraphism (aged from 2 months to 72 years) who were operated on by the first author in 2002-2017. Our findings confirm a high efficacy and low risk of surgical treatment of patients diagnosed with spinal epidermoid cysts. Severe complications of disease progression serve as indications for 'preventive' surgery even in asymptomatic cases. Complete resection of the tumor capsule without deterioration of the functional surgical result is the main goal of surgical treatment. Incomplete resection is associated with a high risk of recurrence. The most thorough follow-up with annual MRI examination is necessary for the first 6 years after surgery.

Congenital dermal sinus with extensive intramedullary expansion and an infected spinal epidermoid cyst in an infant

An 11-month-old female child presented with progressive weakness involving both lower limbs and left upper limb. There was hypertonia and hyperreflexia in the affected limbs. This was associated with multiple episodes of urinary tract infection and overflow incontinence of the urinary bladder. Magnetic resonance imaging of the spine revealed extensive intramedullary expansion of a congenital dermal sinus. There was a cystic lesion along the lower end of the sinus tract. Surgical exploration had confirmed the presence of an infected epidermoid cyst along with the dermal sinus tract. The entire tract as well as the abscessed epidermoid cyst was removed. Following this, the child showed gradual improvement of neurological function and bladder dysfunction. This is perhaps the first report in current literature of a congenital dermal sinus tract with such an extensive intramedullary extension (almost the entire spine) and an infected epidermoid tumor in an infant.

Intramedulary Epidermoid Cyst of the Dorsal Spine: A Case Report.

Spinal epidermoid cysts are cystic tumours lined by squamous epithelium. Unlike dermoid cysts, they do not contain skin appendages (hair follicles, sweat glands, sebaceous glands). They are usually extramedullary but rarely can be intramedullary. They may be congenital or acquired. Especially they are not associated with spinal dysraphism. Intramedullary epidermoid cysts of the spinal cord are rare tumours, only few cases having been reported in the literature. They comprise between 0.5% to 1% of all spinal tumours but account for up to 10% of intraspinal tumours in children. We report a case of 45 years-old female patient who presented with a 18 months history of progressive lower extremity weakness and spasticity. But her bowel/bladder function was normal. Magnetic resonance imaging of the thoracic spine revealed a 3 cm intramedullary mass at the T3-4 level. A T3 to T5 laminnectomy with complete removal of the intradural mass was performed. Intraoperative findings and final histopathological examination revealed an

A rare case of intradural and extramedullary epidermoid cyst after repetitive epidural anesthesia: case report and review of the literature

BackgroundSpinal epidermoid cysts are benign tumors, which are rarely seen as an intradural extramedullary spinal cord tumor in the conus medullaris region. Acquired spinal epidermoid cysts are mostly caused by iatrogenic procedures, such as lumbar puncture, and the majority of acquired spinal epidermoid cysts have been reported below the L1 level, because lumbar puncture is usually performed around the iliac crest. Here, we report an extremely rare case of an epidermoid cyst that occurred as an intradural and extramedullary spinal cord tumor attached to the conus medullaris after repetitive epidural anesthesia.Case presentationA 67-year-old female presented with a low back pain and left sciatica. Although the patient had experienced occasional mild low back pain for several years, her low back pain markedly worsened 2 months before her visit, as well as newly developed left sciatica resulting in intermittent claudication. She had a history of several abdominal surgeries. All abdominal procedures were performed under general anesthesia with epidural anesthesia in her thoracolumbar spine. Magnetic resonance imaging of her lumbar spine demonstrated an intradural extramedullary spinal cord tumor at the T12–L1 level. Because her symptoms deteriorated, the tumor excision was performed using microscopy. Histological examination of the specimens demonstrated that the cyst walls lined with stratified squamous keratinizing epithelium surrounded by the outer layer of collagenous tissue with the absence of skin adnexa. A diagnosis of epidermoid cysts was confirmed. Her MRI showed complete resection of the tumor, and there was no recurrence at 2-year follow-up.ConclusionsIn this case report, epidermoid cells might be contaminated into the spinal canal during repetitive epidural anesthesia. The patient was successfully treated by complete resection, and there was no recurrence at 2-year follow-up with a good clinical outcome. However, long-term follow-up is required for a potential risk of tumor recurrence.

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.

A Congenital Spinal Epidermoid Cyst.

A 73-year-old female with unresolved digestive complaints was referred to our department for CT imaging of the abdomen. Unexpectedly, an oval-shaped, well delineated, intramedullary located mass was found in the spinal canal at the level of the vertebra D11 and D12. On CT imaging the mass is hyperdense to CSF, shows intramural calcification and minimal to no contrast enhancement (Fig. 1A). Proximal to the spinal mass there is a longitudinal split in the spinal cord, diastematomyelia, associated with a congenital block vertebra and hemivertebra at the level of D9–D10 (Fig. 1B). There is also an unfused spinous process of D9 and D10, an anatomical variant which is part of the spectrum of spina bifida occulta (Fig. 1C). The patient has no symptoms of low back pain and no abnormalities in the neurological clinical examination. MR imaging is required for further differentiation of the mass and shows a well-defined lesion without perilesional edema, with hyperintense signal on T1 weighted images (Fig. 2A), inhomogeneous, isointense to hypointense signal on T2 weighted images (Fig. 2B) and no significant enhancement after contrast administration. For further differentiation diffusion weighted imaging (Fig. 3A) was performed and revealed diffusion restriction with corresponding low intensity on ADC map (Fig. 3B) in the entire mass, except in the region of calcification. These findings, in association with the spinal malformations (spina bifida, diastematomyelia, block vertebra and hemivertebra) are highly specific for a congenital spinal epidermoid cyst. The diastematomyelia is best shown on the coronal T2 weighted image in Fig. 4.