Iatrogenic Intraspinal Epidermoid Cyst

Abstract

Epidermoid cyst is generally regarded as congenital disease, and commonly related to other congenital spinal anomalies. However, it also develops iatrogenically. We report one rare case of epidermoid cyst that we experineced among intradural extramedullary tumors. A 21-year-old female patient was admitted to the hospital due to low back pain with radiating pain into a right lower extremity that initiated about a month ago. She complained sensory lose and motor weakness (grade 4+) on her right extremity as well as urinary dysfunction and sphincter dysfunction. She had a lumbar puncture three times due to Pneumococcal meningitis when she was 13 years old. The well-circumscribed intradural extramedullary mass of 1.8×1.6×4 cm size was found on the L4-5 in a magnetic resonance image. Gross total tumor removal was garried out after the total laminectomy L5 and partial laminectomy L4. The tumor mass was gray-colored and so fragile that it was easy to be removed. The histological diagnosis confirmed epidermoid cyst without malignancy. After the operation, the patient progressively showed remarkable neurological recovery. In this case, the cause of epidermoid cyst is considered iatrogenic concerning history of several times of lumbar puncture as meningitis.

Possible Double Crush Syndrome Caused by Iatrogenic Acquired Lumbosacral Epidermoid Tumor and Concomitant Sacral Tarlov Cyst

“…The present case showed rim enhancement of solid lesion mimicking a schwannoma; however, there was no enhancement of cystic lesion, indicating two different lesions. Spinal ETs are still difficult to diagnose particularly for small-sized tumors like the present case because they typically show negative contrast enhancement 8,9) and similar signal to CSF on MRI. 2,[10][11][12] ETs can show atypical signal intensity changes, such as hyperintense signal on T1WI and hypointense signal on T2WI.…”

“…This variability in signal characteristics might be related to the chemical state of cholesterol or the relative composition of cholesterol and keratin and makes preoperative diagnosis difficult. 8,9) The etiologies of spinal ETs are thought to be both congenital and acquired. Acquired ETs were mostly reported in the region of the cauda equina (below the L1 level) 5,13) because lumbar punctures are usually performed around that level.…”

“…This variability in signal characteristics might be related to the chemical state of cholesterol or the relative composition of cholesterol and keratin and makes preoperative diagnosis difficult. 8 , 9) …”

Lumbar laminotomy and replantation for the treatment of adult spinal epidermoid cyst

“…Different from most of the intracranial epidermoid cysts which are congenital, most intradural extramedullary epidermoid cysts are acquired. [ 7 ] Congenital spinal epidermoid cysts are commonly associated with spinal deformity. [ 8 , 9 ] This patient, who had no congenital spinal malformations such as hemivertebrae and spina bifida, was considered to be iatrogenic.…”

Intradural iatrogenic epidermoid cyst at cauda equina: A case report

“…[ 3 , 4 ] However, they may also be attributed to the innoculation of epidermal components into the spinal canal secondary to trauma, surgery, or a lumbar puncture. [ 2 , 6 ]…”