Spinal Epidermoid Cyst Research Articles

Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine

Study designThis was a retrospective study.ObjectiveThe aim of this study was to analyze the clinical characteristics and discuss the treatment options for epidermoid cysts in the lumbar spine.Summary of background dataEpidermoid cysts are rare benign neoplasms, which account for less than 1% of all intraspinal tumors. Due to their rarity, there are only a few case reports in the literature. Complete excision is the recommended treatment for an epidermoid cyst, but this is difficult to achieve in the spine. In spite of their benign nature, local recurrence is not uncommon for spinal epidermoid cysts after incomplete excision.MethodsSix patients with an epidermoid cyst in the lumbar spine underwent surgical treatment in our center between 2004 and 2011. A total excision using microsurgical techniques and reconstruction was successfully undertaken in all patients. Clinical data and detailed pathologic results were retrospectively analyzed. All cases were followed up for a median time of more than 4 years. The clinical data and surgical efficacy were analyzed to suggest treatment options for epidermoid cysts in the lumbar spine on the basis of a literature review and our own experience.ResultsThe mean age of the patients in this study was 37.7 years and the mean duration of pre-operative symptoms was 29.7 months (2 to 120 months). All patients were disease-free during their follow-up period. Radicular pain nearly disappeared, and patients suffering from neurologic deficits and defecation disorders recovered well.ConclusionsAlthough an epidermoid cyst is a benign tumor, it is apt to recur locally following inadequate removal. Therefore, complete excision with preservation of neural function is an ideal protocol for intraspinal epidermoid cysts. Microsurgical techniques are very useful.

Paraplegia due to Spinal Epidermoid Cyst Rupture at Asthma Attack

Spinal epidermoid cyst is less than 1% of the entire spinal cord tumor and a rare tumor. It is a slowly proliferating benign tumor and can be a result of either congenital or acquired factors. In particular, reports of acute paraplegia due to spinal epidermoid cyst rupture are very rare. Since authors experienced paraplegia resulting from congenital spinal epidermoid cyst rupture during an asthma attack, it is reported with a review of literature.

Phosphodiesterase 11A (PDE11A) Expression in Mouse Tissues and Characterization of a PDE11A Mouse Knock-Out Model

Phosphodiesterases catalyze the hydrolysis of cyclic nucleotides and maintain physiologic levels of intracellular concentrations of cAMP and cGMP. Increased cAMP signaling has been associated with genetics disorders that lead to adrenocortical tumors and Cushing syndrome. Genetics defects in the phosphodiesterase 11A (PDE11A) are associated with increased levels of cAMP and bilateral adrenal hyperplasia; they also contribute to the development of adrenocortical, prostate, and testicular tumors in the general population. The aim of the present work is to study the expression of Pde11a in mouse tissues, as well as to understand better the Pde11a defect in a previously published Pde11a–/– knockout (KO) mouse model.1A colony of Pde11a–/– (KO), Pde11a+/– (Het) and wild type (wt) mice was studied in a complete phenotypical groß and microscopy pathological study. Molecular, immunohistochemical and biochemical studies were done to determine the function and expression of Pde11a in the tissues of normal and mutant mice. In normal mice higher PDE11A immunoreactivity(PDE11A-IR) was found in small intestine villi, thyroid follicular cells, prostate and spermatocytes; moderate PDE11A-IR in brain, liver hepatocytes, and exocrine pancreas and little, if any, in the pituitary gland. In mutant mice RNA studies showed a reduced Pde11a expression in steroidogenic tissues (adrenals and testis), lung, brain, and liver while prostate and kidney presented comparable expression with normal mice. PDE11A protein expression and activity assays did not show differences among three groups. Pathological studies showed differences: Adrenal subcapsular hyperplasia and foamy cells were more frequent in Het(37.7% and 30.2% respectively, p<0.05) than in wt group (26.3% and 15.8% respectively); Spinal epidermoid cyst in Het (15%) and wt mice (10%); kidney-pelvis interstitial lymphocytes only in KO mice (10.7%, P<0.05). KO mice showed increased absolute and organ specific weight. This study show a clear profile of Pde11a protein expression in endocrine and other mouse tissues, as well as convincing evidence of only partial Pde11a suppression in the previously published KO mouse. These mice developed adrenal hyperplasia and other abnormalities like humans with heterozygote PDE11A defects and partial inactivation of the enzyme. These data support the involvement of PDE11A in the pathogenesis of adrenocortical hyperplasia, but also provide significant insight into a previously reported mouse model.

Diffusion-weighted MR imaging (DWI) in two intradural spinal epidermoid cysts

Diffusion-weighted MR imaging (DWI) in two intradural spinal epidermoid cysts

Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region

The aim of this study was to evaluate the characteristics and surgical outcome of spinal epidermoid and dermoid cysts in the lumbosacral spine. We reviewed 26 patients with spinal epidermoid and dermoid cysts (15 epidermoid and 11 dermoid) treated between October 2000 and December 2010. The latter 15 patients of this series underwent neurophysiological monitoring during surgery. Gross total resection of the tumour was achieved in 46.2% of patients, and 53.8% underwent subtotal resection. In 14 patients, the tumour capsule adhered so tightly to the neural structures that a section of the capsule remained in situ. After surgery, the Japanese Orthopaedic Association score improved in 80.8% of patients, remained stable in 15.4%, and declined in 3.8%. The average follow-up period was 53months. Three patients developed recurrence of the tumour and 20 patients resumed a normal working life. Microsurgical techniques and intraoperative neurophysiological monitoring are practical and reliable methods for radical removal of spinal epidermoid and dermoid cysts that involve the conus medullaris and cauda equina.

Iatrogenic Spinal Epidermoid Cyst After Lumbar Puncture Using Needles with Stylet

Iatrogenic spinal epidermoid tumors are extremely rare and may be caused by implanted skin fragments in the spinal canal, most commonly due to lumbar punctures using hollow needles without a stylet. The authors report for the first time an iatrogenic spinal epidermoid tumor that developed 26 months after several lumbar punctures, performed using disposable spinal needles with stylet, in an 8-year-old boy with persistent lower back pain. The authors hypothesize that an ill-fitting stylet compounded by multiple therapeutic lumbar punctures and young age as possible risk factors for the development of the tumor in the present case. A total excision of the tumor with laminectomy yielded good symptomatic recovery.

Spinal Epidermoid Cyst in a SJL Mouse: Case Report and Literature Review

This report is the first description of a spinal epidermoid cyst (EC) in a SJL mouse and gives an overview on the occurrence of ECs in animals including dogs, horses, mice and rats. The EC was not detected grossly and the mouse did not display clinical signs or an altered rotarod performance. Microscopically, there was an oval cyst lined by stratified squamous epithelium that was attached to the dorsolateral meninges and caused moderate compression of the adjacent lumbar spinal cord. ECs in mice and rats are mainly located in the caudal part of the spinal cord with a variable, strain-dependent occurrence. ECs in mice and rats are not associated with clinical signs and can be interpreted as incidental findings.

Spinal epidermoid cyst formation after spinal fracture operation: a case report

Acquired spinal epidermoid cysts are extremely rare. There are only a few reports on the formation of epidermoid cysts after lumbar puncture or spinal trauma. In this report, we present a patient who was diagnosed with epidermoid cyst after operation for spinal fracture. This 43-year old female suffered from progressively worsening low back pain radiating down the left leg four years after lumbar burst fracture in the L1 segment and subsequent posterior vertebral pedicle screw fixation surgery. 1 year later, the spinal fracture fixation devices were successfully removed. On admission, spinal magnetic resonance imaging found a cyst locating anterior to the site of operation and this lesion was removed by a following total laminectomy. To the best of our knowledge, this is the first case ever reported showing the formation of epidermoid cyst after primary spinal fracture operation. Therefore, in patients with a history of spinal fracture operation, spinal epidermoid cysts should be taken into consideration if the low back pain and radiculopathy were refractory.

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.

Giant intramedullary epidermoid extending from brain stem to upper thoracic spinal cord.

Epidermoid cysts are benign tumors originating from ectoderm remnants. Most epidermoid cyst cases are intracranial. Spinal epidermoid cysts are uncommon and most of the reported cases are in the thoracic and lumbar spine. Occurrence of intramedullary epidermoid cysts in the cervical spine is extremely rare. An 18-year-old male with a giant intramedullary tumor extending from the brain stem to the upper thoracic spinal cord presented at our outpatient department. The patient underwent total excision of a silvery white lesion through a midline myelotomy. Histopathological examination was suggestive of an epidermoid cyst. We present a brief report of the case and discuss the relevant 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.

Spinal epidermoid cyst with sudden onset of paraplegia

Spinal epidermoid cysts, whether congenital or iatrogenic, are relatively uncommon in the spinal cord. When they occur, the typical location is in the subdural, extramedullary space of the lumbo-sacral region. We describe an unusual presentation in a 3-year-old male child which mimicked astrocytoma clinicoradiologically. The child developed sudden onset of inability in walking and weakness of both lower limbs after a fall. There was a dramatic reversal of symptoms after surgery. Histopathology revealed an epidermoid cyst of the spine. On the first follow-up visit at 3 months, the child was asymptomatic.

Dorsal intramedullary spinal epidermoid cysts: Report of two cases and review of literature

Intramedullary epidermoid cysts of the spinal cord are rare tumors, especially those not associated with spinal dysraphism. About 50 cases have been reported in the literature. Of these, only seven cases have had magnetic resonance imaging (MRI) studies. We report two cases of spinal intramedullary epidermoid cysts with MR imaging. Both were not associated with spina bifida. In one patient, the tumor was located at D4 vertebral level; while in the other, within the conus medullaris. The clinical features, MRI characteristics and surgical treatment of intramedullary epidermoid cyst are presented with relevant review of the literature.

Congenital spinal epidermoid cyst presenting as abscess of the spinal cord

Epidermoid cyst in the spinal cord is a rare condition. The majority arise in the cerebellopontine angle or parasellar. They are considered malformations due to incorporation of ectoderm into the folds of the developing nervous system at the time of closure of the neural tube (3.-5. gestational week). They consist of delicate connective-tissue capsule lined by laminated squamous epithelium filled with keratin. In the majority they are associated by further dysrhaphic malformations like dermalsinus, which can be the cause for secondary infection.

Intramedullary epidermoid cyst presenting with abnormal urological manifestations

Report of an epidermoid cyst with intramedullary localization. To describe an atypical presentation of intramedullary epidermoid cyst. Intramedullary epidermoid cysts are rare entities with a marked variability in the clinical presentation, essentially of neurological pertinence. Case report of a spinal epidermoid cyst in a 13-year-old girl presenting with urological symptoms: she had a 12-month history of recurrent low urinary tract infections, urinary frequency and nocturnal enuresis. A urodynamic evaluation was performed and showed the presence of involuntary bladder contractions with detrusor instability and low bladder compliance. Magnetic resonance imaging of the spine demonstrated an intramedullary lesion of the dorsal spinal cord. The mass was excised and 6 months after surgical excision, urological manifestations improved with decreased detrusor hyper-reflexia, increased bladder capacity and compliance and no later report of urinary tract infections. In our patient, unusual clinical manifestations of the tumor have delayed the diagnosis, but its complete removal has led to remission of symptoms. Detailed neurological examination and investigations are indicated in patients with clinical and urodynamic features, suggestive of neuropathic bladder.

Spinal epidermoid cyst in the mouse. An ultrastructural study.

Ultrastructural features of epidermoid cysts in the spinal leptomeninges were studied in two strains of mouse. Although the cysts were lined by stratified squamous epithelium, the normal sequence of epidermal differentiation in this epithelium was not observed in that the basal cell layer was absent in certain areas. The morphological features and genesis of this phenomenon are briefly discussed.

Growth of dermoids from skin implants to the nervous system and surrounding spaces of the newborn rat.

T HERE is significant evidence supporting the concept of t r auma as the cause of some spinal epidermoid cysts. Many reports refer to spinal epidermoids tha t developed several years following single or multiple lmnbar punctures. In most instances the taps were per formed for the diagnosis and t r ea tmen t of tuberculous meningitis. Choremis, et al., 4 were the first to suggest a relationship between direct implantat ion of epidermis by a lumbar puncture needle and subsequent t umor formation. Gibson TM demons t ra ted t ha t in over 60% of skin punctures a small piece of epidermis remains in the needle. He also produced dermoids by subcutaneous implanta t ion of skin into rats. Successful skin t ransplants to the central nervous sys tem in exper imental animals have not been reported as far as we know. We describe here a simple method for the direct implantat ion of skin honlografts into the spinal epidural and subarachnoid spaces of immature animals and even into the cord itself. Similar implants into frontal cortex have also been successful.