Spinal dermoid tumours

Cervical intradural extramedullary epidermoid cyst at the background of congenital scoliosis with a semi-segmented C6 hemivertebra

In the present case study, we present a female adolescent patient harboring a rare clinical presentation of spinal intradural extramedullary epidermoid cyst concomitant with congenital scoliosis. A 17-year-old female patient was admitted to the clinic with long-lasting neck pain. She was neurologically intact yet had cervicothoracic scoliosis. Cervical MRI and CT depicted a right C6 hemivertebra, fused to the lower endplate of the C5 vertebra. At the same vertebra level, she had an intradural extramedullary mass lesion anterior to the spinal cord. We planned to excise the mass lesion first. We used neuromonitoring during the surgery and made the surgery via posterior approach. We observed a pearl-like mass lesion anterolateral to the spinal cord. We excised the mass lesion with its capsule microsurgically via peace-meal route. She was neurologically stable following the surgery. Histopathological diagnosis was epidermoid cyst. Most of spinal inclusion cysts occur secondary to spinal dysraphism or iatrogenic inoculation. Isolated spinal inclusion cyst located anterior to the spinal cord concomitant with vertebral anomalies should be kept in mind before making proper surgical planning. Surgery is the modality of choice for spinal inclusion cyst and should be performed under the guidance of neuromonitoring, especially in cases with lesions located at higher spinal levels.

An Infected Dermoid Cyst Without a Sinus Tract: A Rarity Mimicking a Spinal Tumor

Spinal dermoid cysts are rare and account for 0.8% to 1.1% of spinal intramedullary Tumors. Only a few cases of infected spinal dermoid cysts have been reported in the literature and most of them were associated with a dermal sinus as the source of infection. We report a case of an infected spinal dermoid cyst in the absence of a dermal sinus in a 3-year-old child who underwent excision of cyst. On a long-term follow-up of about 10 years, there was no evidence of any recurrence. However, bowel and bladder dysfunction persisted. In the light of the current literature, we discuss the clinical presentation, etiopathogenesis, radiological features, management, and long-term outcome of an infected conus dermoid cyst.

Thoracic congenital dermal sinus associated with intramedullary spinal dermoid cyst

Dorsal dermal sinus is a rare, congenital lesion found most frequently in the lumbosacral followed by the occipital regions. It is rarely localized at the thoracic level. We report a rare case of thoracic congenital dermal sinus (CDS) associated with an intramedullary dermoid cyst in a 2-year-old male child, who presented with a 3 month history of motor weakness of both the lower extremities. Magnetic resonance imaging (MRI) of spine showed an intramedullary dermoid cyst extending from the lower border of T4 to upper border of T7, which was connected with the skin dimple along the sinus tract. Total excision of the dermoid cyst and the sinus tract with T5-7 laminectomy resulted in good functional recovery.

Spinal inclusion cysts

BACKGROUND

Dermoid and epidermoid tumours are related though pathologically distinct entities that can be combined under the term inclusion cysts. Most are of developmental origin and in the spine may be intramedullary, intradural extramedullary or extraspinal in location. The terminology, aetiology, radiology and optimal management of spinal inclusion cysts have been the source of ongoing controversy.

AIMS

A retrospective review of surgical cases from a single institution has been conducted, and this experience is discussed in the context of the existing literature.

RESULTS

Sixteen cases of paediatric spinal inclusion cysts were treated between 2002 and 2012. Associated anomalies included dermal sinus track (11), previous myelomeningocele (4) and Currarino syndrome (1). The lesions spanned 1-8 spinal levels; in half the cases, there was a history of secondary infection at the time of presentation. The aim of treatment was complete excision, and macroscopic removal was achieved in all cases. The most significant adverse outcome was related to sphincter dysfunction, and this was observed in four cases, two with a prior history of myelomeningocele and two who had presented with active infection. No instances of recurrence were recorded during a median follow up of 7.4 years (range 1-11 years).

CONCLUSIONS

Spinal inclusion cysts are aetiologically diverse lesions, though in paediatric practice, most occur in association with a dysraphic anomaly. There are no consistent clinical or radiological features that will reliably distinguish between dermoid and epidermoid, and both may result in symptoms from mass effect or infection. The recurrence rate is low if complete macroscopic resection can be achieved.

Dorsal intramedullary dermoids

We report a case of a 31-year-old woman with an intramedullary thoracic dermoid, who had progressive spastic paraparesis in her lower extremities over a period of three years, as well as loss of bowel and bladder control. She had been operated for "spina bifida" at three days of age but had no neurologic deficit. MRI of the thoracic spine showed an intramedullary hypointense lesion at T7-T8, associated with an intramedullary lipoma at a higher level. Intracapsular resection of an intramedullary dermoid cyst was performed. We review the literature on intramedullary dermoids differentiating them from the more common, but still rare, lumbosacral subdural juxtamedullary dermoids. We discuss the associated malformations with these lesions, as well as their pathophysiology and treatment. Although uncommon, dorsal intramedullary dermoids should be suspected and treated in a timely manner, especially in presence of other congenital anomalies.