Concurrent Thoracic Spinal Intradural Extramedullary Epidermoid and Neurenteric Cyst in a Spinal Dysraphism Child

Abstract

<b><i>Introduction:</i></b> Intraspinal epidermoid cysts are congenital or acquired in origin; whereas intraspinal neurenteric cysts (NECs) are of congenital origin. Their individual association with spinal dysraphism and vertebral segmentation anomalies is very well known. <b><i>Case presentation:</i></b> We hereby report a case of concurrent intradural extramedullary epidermoid and NEC at adjacent vertebral levels in a spinal dysraphism child, not reported in English Literature till now. <b><i>Conclusion:</i></b> Multiple spinal lesions related to any/all of the 3 germ layers can coexist at same or adjacent vertebral levels in the same patient and surgical planning shown to be done accordingly.

Radiographic and clinical features of thoracic intradural extramedullary epidermoid tumor: Illustrative case

“…This is confirmed by the association between spinal epidermoid tumors and developmental pathologies like spinal dysraphism, hemivertebra, diastematomyelia, and dermal sinus tract lesions. Congenital spinal epidermoids are often located along the midline, often dorsal to the cord and can be either intramedullary or extramedullary [8]. Conversely, acquired lesions develop due to traumatic or iatrogenic implantation of skin fragments into the intrathecal space following lumbar puncture or spinal surgery [4].…”

Ossified upper thoracic intradural mature teratoma in a teenager – A technical case report with special emphasis on surgical strategy

“…Pre-operative CEMRI spine [Figure 1a. [1][2][3][4][5] showed a rim enhancing ventrally placed cystic intradural lesion at D2-3 vertebral body level without any diffusion restriction. Another heterogeneous lesion was noted posteriorly at D3-4 vertebral body level causing thinning of thoracic cord due to impingement between the larger ventral and smaller dorsal lesion.…”

“…Pre-operative computed tomography (CT) [Figure 1b. [1][2][3][4] showed a non-uniformly thick continuous crescent-shaped ossification (>1000 Hounsfield unit [HU]) in the dorsal portion of spinal canal.…”

“…His lower limbs tone was still high (reduced compared to pre-operative status) without any improvement in motor power along with complete sensory loss below nipples and complete loss of bowel and bladder sensations at 8 months follow-up without any radiological recurrence [Figure 1d. [1][2][3][4][5].…”

“…Provisional diagnosis of a heterogeneous, ossified intradural benign spinal tumor such as meningioma or nerve sheath tumor; or a ruptured neurenteric cyst/dermoid with ossification of spilled out material; or presence of dual pathologies was kept. [ 4 ] After D1-D4 laminectomy in prone position, hypervascular but normal looking duramater was opened in midline. There were dense but dissectable adhesions between the inner surface of the duramater and the underlying ossified tissue throughout the extent of laminectomy.…”