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Mahajan UV, Labak KB, Labak CM, Herring EZ, Hdeib AM. Images in Spine: A Rare Abnormal Bony Fusion. Cureus 2021; 13:e13719. [PMID: 33833930 PMCID: PMC8019583 DOI: 10.7759/cureus.13719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Klippel-Feil syndrome (KFS) is characterized by failed segmentation of the cervical spine leading to inappropriately fused vertebral bodies. A 64-year-old male with a previous L5-S1 decompression presented with significant neck pain with radiation into the entire right upper extremity and hand. Imaging demonstrated fusion of the vertebral bodies at C2-3, C4-6, and C7-T1 with associated disc bulges at C3-4 and C6-7. Common presentation of KFS includes significant spondylosis and cervical myeloradiculopathy in addition to the classic triad of short neck, low posterior hairline, and restricted neck motion. We present exemplary images of this rare condition to aid clinicians in future diagnoses.
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Affiliation(s)
- Uma V Mahajan
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Kyle B Labak
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Collin M Labak
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Eric Z Herring
- Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Alia M Hdeib
- Neurological Surgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, USA
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Chung LK, Lagman C, Duong C, Nagasawa DT, Tucker AM, Yong WH, Yang I. Dermoid Cyst of the Prepontine Cistern and Meckel's Cave: Illustrative Case and Systematic Review. J Neurol Surg B Skull Base 2017; 79:139-150. [PMID: 29868318 DOI: 10.1055/s-0037-1604332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 06/10/2017] [Indexed: 10/19/2022] Open
Abstract
Objective Dermoid cysts are benign, congenital malformations that account for ∼0.5% of intracranial neoplasms. The authors describe a 42-year-old female with a prepontine dermoid cyst who underwent apparent gross total resection (GTR) but experienced cyst recurrence. To date, very few cases of prepontine dermoid cysts have been reported. The prevalent region where these cysts are located can be difficult to determine. In addition, the authors systematically review the literature to characterize the clinical presentation, anatomical distribution, and surgical outcomes of intracranial dermoid cysts. Design Systematic review. Setting/Participants PubMed, Web of Science, and Scopus databases. Main Outcome Measures Extent of resection, symptom improvement, and recurrence rates. Results A total of 69 patients with intracranial dermoid cysts were identified. Three (4.3%) intracranial dermoid cysts were located in the prepontine cistern. The average age of patients was 33.3 years. The most common presenting symptoms were headache (52.2%) and visual disturbances (33.3%). Intracranial dermoid cysts were distributed similarly throughout the anterior, middle, and posterior cranial fossae (29.0%, 36.2%, and 29.0%, respectively). GTR was achieved in 42.0% of cases. Thirty-four (49.3%) patients experienced symptom resolution. Recurrence rate was 5.8% at a mean follow-up of 2.1 years. Conclusions Intracranial dermoid cysts most often present as headaches and visual disturbances. Intracranial dermoid cysts were found in the anterior, middle, and posterior cranial fossae at similar frequencies but with clear predilections for the Sylvian fissure, sellar region, and cerebellar vermis. Outcomes following surgical excision of intracranial dermoid cysts are generally favorable despite moderate rates of GTR.
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Affiliation(s)
- Lawrance K Chung
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Carlito Lagman
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Courtney Duong
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Daniel T Nagasawa
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Alexander M Tucker
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - William H Yong
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States.,Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States.,Jonsson Comprehensive Cancer Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States
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Teegala R. Posterior fossa infected dermoid with congenital heart disease: A novel hypothesis of an unusual association. J Pediatr Neurosci 2015; 10:250-3. [PMID: 26557168 PMCID: PMC4611896 DOI: 10.4103/1817-1745.165681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Intracranial dermoid cysts commonly present as a discharging sinus, local swelling, mass lesion, or abscess formation. These can sometimes be found in association with congenital anomalies. The author presents two original cases of infected posterior fossa dermoid associated with congenital heart diseases (CHDs) that is very rare. The embryologic basis for this unique occurrence is reviewed, and a new hypothesis proposed. Two infants with CHD presented with infected midline posterior fossa dermoid. Excision of the dermoid cyst with the sinus tract was performed. Postoperative period was uneventful. Both the infants had undergone surgery for congenial heart disease a few months prior to the present clinical presentation with uneventful recovery. Infected posterior fossa dermoid cyst without a discharging sinus should prompt a thorough examination to detect CHD. Early diagnosis and timely management results in better outcome.
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Affiliation(s)
- Ramesh Teegala
- Department of Neurosurgery, Alluri Sita Ramaraju Academy of Medical Sciences, West Godavari, Andhra Pradesh, India
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Adorno A, Alafaci C, Sanfilippo F, Cafarella D, Scordino M, Granata F, Grasso G, Salpietro FM. Malignant teratoma in Klippel-Feil syndrome: a case report and review of the literature. J Med Case Rep 2015; 9:229. [PMID: 26438353 PMCID: PMC4595139 DOI: 10.1186/s13256-015-0700-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 08/31/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction Klippel–Feil syndrome is characterized by a congenital fusion of cervical vertebrae. Intracranial teratomas are nongerminomatous germ cell tumors and they account for 0.3 to 0.9% of all intracranial tumors. Teratomas with malignant transformation refer to lesions which give rise to malignant cancer of somatic type. The association between tumors of dermoid origin and Klippel–Feil malformation is extremely rare. Only 23 other cases have so far been reported, and only one case of dermoid tumor with areas of dedifferentiation on squamous cell carcinoma has been described. Case presentation We report the case of a 72-year-old white man with a 2-year history of gait and balance disturbances. A brain magnetic resonance imaging revealed a fourth ventricle neoplastic process with infiltrative features. He was operated through a suboccipital craniectomy with a C1 laminotomy and bilateral vertebral artery transposition. At 6-months follow-up, magnetic resonance imaging showed an early regrowth of the fourth ventricle tumor, with the same radiological features. Conclusions Patients with Klippel–Feil malformation could develop posterior fossa dermoid tumors. The malignant potential of such tumors must be considered and surgery is recommended. Particular attention must be focused on the histopathological analysis in order to identify possible foci of malignant transformation.
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Affiliation(s)
- A Adorno
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - C Alafaci
- Department of Neurosurgery - AOU Policlinico "G.Martino", Via Consolare Valeria, 98125, Messina, Italy.
| | - F Sanfilippo
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - D Cafarella
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - M Scordino
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
| | - F Granata
- Department of Neuroradiology, University of Messina, Messina, Italy.
| | - G Grasso
- Department of Neurosurgery - BIONEC, University of Palermo, Palermo, Italy.
| | - F M Salpietro
- Department of Neurosurgery - AOOR Papardo-Piemonte, Contrada Papardo, 98158, Messina, Italy.
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Barrios N, Gómez M, Mieres M, Vera F, Alvial G. Spinal dermoid sinus in a Dachshund with vertebral and thoracic limb malformations. BMC Vet Res 2014; 10:54. [PMID: 24593884 PMCID: PMC3975874 DOI: 10.1186/1746-6148-10-54] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 02/24/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Dermoid sinus is an uncommon epithelial-lined fistula that may be associated with vertebral malformations. In humans, Klippel-Feil syndrome (KFS) is a rare condition characterized by congenital cervical vertebral fusion and may be associated with other developmental defects, including dermoid sinus. The present case report describes an adult Dachshund with cervical and cranial thoracic vertebral malformations as well as thoracic limb malformations resembling KFS with a concurrent type IV dermoid sinus. CASE PRESENTATION A 1.5 year-old Dachshund with congenital thoracic limbs deformities and cervical-thoracic vertebral malformations presented with cervical hyperesthesia, rigidity of the cervical musculature and tetraparesis. Neurologic, radiographic, and computed tomography (CT) (2D, 3D, CT fistulography) examinations revealed skeletal anomalies, a dermoid sinus in the cranial thoracic region and epidural gas within the vertebral canal. Surgical resection and histopathological evaluation of the sinus tract were performed and confirmed a type IV dermoid sinus. The clinical signs progressively recovered postoperatively, and no recurrent signs were observed after 6 months of follow-up. CONCLUSIONS Cervical vertebral malformations associated with limbs anomalies have not been reported in dogs and may represent a condition similar to KFS in humans. KFS can occur concurrently with other congenital conditions including dermoid sinus and should be included among the complex congenital anomalies described in dogs.
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Affiliation(s)
- Natasha Barrios
- Hospital Veterinario, Universidad San Sebastián, Puerto Montt, Chile
| | - Marcelo Gómez
- Instituto de Farmacología y Morfofisiología, Universidad Austral de Chile, Casilla 567, Valdivia, Chile
| | - Marcelo Mieres
- Instituto de Ciencias Clínicas Veterinarias, Universidad Austral de Chile, Casilla 567, Valdivia, Chile
| | - Frank Vera
- Hospital Veterinario, Universidad San Sebastián, Puerto Montt, Chile
| | - Genaro Alvial
- Institutio de Anatomía, Histología y Patología, Universidad Austral de Chile, Casilla 567, Valdivia, Chile
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McLaughlin N, Weil AG, Demers J, Shedid D. Klippel-Feil syndrome associated with a craniocervico-thoracic dermoid cyst. Surg Neurol Int 2013; 4:S61-6. [PMID: 23646276 PMCID: PMC3642751 DOI: 10.4103/2152-7806.109440] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 12/03/2012] [Indexed: 11/10/2022] Open
Abstract
Background: Uncommonly, Klippel–Feil syndrome (KFS) has been associated with intracranial or spinal tumors, most frequently dermoid or epidermoid cysts. Although the associated dermoid cyst (DC) is usually located in the posterior fossa, isolated upper cervical DC has been reported. Extension from the posterior fossa to the upper cervical spine (C2) has been reported once. We report a rare case of KFS in association with a posterior fossa DC that extended down to the upper thoracic spine and review the current literature. Case Description: A 47-year-old female with presented cervical myelopathy related to a cranio-cervico-thoracic DC in association with KPS-related cervicothoracic fusion (C2-T6) and thoracic kyphosis. The patient underwent complete tumor resection following sub-occipital craniectomy and C1-C4 cervical laminectomy. The patient exhibited complete resolution of symptoms with no tumor recurrence and no deformity at 6-year follow-up. Conclusion: DC should be added to the list of congenital central nervous system abnormalities, which should be sought in patients with KFS. Therefore, the presence of a cystic lesion in the posterior fossa, the craniocervical junction or the anterior cervical spine should suggest the possibility of a DC in patients with KFS. In cases of cranio-cervical DC, the tumor may extend quite far down the spinal column (reaching the thoracic spine), as demonstrated in the present case.
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Affiliation(s)
- Nancy McLaughlin
- Department of Surgery, Division of Neurosurgery, Spine Unit, Centre Hospitalier de l'Université de Montréal - Hôpital Notre-Dame, Canada
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Valiaveedan SS, Rath GP, Bithal PK, Ali Z, Prabhakar H. Posterior fossa dermoid: yet another cause of difficult airway? J Anesth 2008; 22:446-8. [PMID: 19011786 DOI: 10.1007/s00540-008-0644-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 05/05/2008] [Indexed: 11/27/2022]
Abstract
Klippel-Feil syndrome and craniovertebral junction anomalies are known to pose challenges while the airway is being secured. These anomalies may occur in association with dermoid and epidermoid cysts in the posterior fossa. We present a case of posterior fossa dermoid with extracranial extension that caused severely restricted neck movement. As these anomalies seem to form part of a single, unnamed syndrome, the possibility of upper cervical spine abnormality leading to a difficult airway should be anticipated in patients with posterior fossa dermoid.
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Affiliation(s)
- Sebastian S Valiaveedan
- Department of Neuroanaesthesiology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
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