Spinal epidermoid cyst
Epidermoid and dermoid cyst comprise <1% of spinal tumors and may be congenital (hamartoma) or acquired (iatrogenic) in origin.
Approximately 60% of epidermoid cysts are intradural extramedullary and 40% are intramedullary. In approximately 5% of cases, there are multiple lesions.
1% of spinal cord tumors. In particular, intramedullary epidermoid cysts are extremely rare 1).
Case reports
A case of a spontaneous intradural epidermoid cyst at cauda equina level in a 9-year-old patient, which is believed the first case to be reported in Vietnam.
This 9-year-old boy presented with 4 months of spontaneous left lower extremity muscle weakness and paresthesia. The MRI images suggested the diagnosis of an intradural epidermoid cyst at cauda equina level. The patient underwent L5-S1 laminectomy and durotomy for tumor resection. The histology confirmed the diagnosis of an epidermoid cyst. Post-operative images demonstrated total cyst removal.
Diagnosis 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 postoperative magnetic resonance imaging and tumor marker is helpful 2).
A case of an acquired intradural extramedullary epidermoid cyst involving the thoracic region in an adult female who had no associated history of an accompanying congenital spinal deformity.
Early diagnosis and immediate surgical intervention reduce patient morbidity. Near complete or subtotal excision of the cyst wall is warranted to prevent inadvertent injury to the spinal cord thus minimizing neurological morbidity 3).
1983
Martinez-Lage et al. report the case of an infant who presented with an epidermoid tumor contained in a lumbosacral myelomeningocele. The association of spina bifida aperta and congenital intraspinal tumors is rare. Only two cases of teratoma and two cases of epidermoid tumors arising within a meningocele have been documented previously 4).