Intramedullary Teratomas: Two Case Reports and a Review of the Literature

Abstract

Surgery is the therapy of choice in cases of intramedullary teratomas; the removal, though incomplete, leads to a definite improvement of symptoms. In our two cases the follow-up has been 7 years and 6 years, respectively. No tumour regrowth occurred during this period.

Exophytic Intramedullary Mature Teratoma of the Conus Medullaris: Case Report and Review of the Literature

“…As in the presented case, the most frequent complaint is pain, either radicular or in the lower back [62,69] . Since approximately every third case of intramedullary teratoma was localized in the conus medullaris [16] , urinary disturbances were reported in as many patients [39,62,69] . Neurological examination reveals motor, sensory or refl ex abnormalities of the lower extremities [62,69] suggestive of nerve root or spinal cord compression, often similar to that caused by degenerative changes [15] .…”

“…When fi nding a congenital abnormality, teratoma should be included in the diff erential diagnosis and whole-spine MRI is indicated in order to defi ne any other congenital lesion [15,20,54] . The usual MRI fi nding is a tumor of a heterogeneous nature, with hypo-and hyperintense areas, almost non-existent contrast enhancement, areas of calcifi cations, fat and cysts [16] . A spin-echo sequence with prolonged repetition time is thought to provide the best diff erentiation between the tissues [52] .…”

“…Attempting radical resection, we encountered an area of intimate adhesions of the teratoma with the medullary parenchyma, and the remaining tumor could not be removed safely. This intimate relationship was the cause of subtotal resection [1, 16,64] . Subtotal resection is advocated in cases where the teratoma cannot be removed without risk of medullary injury [1, 16,32,35,49,58] , a situation similar to the treatment of other intramedullary tumors [13] .…”

“…The fi rst proven case was described by Hosoi in 1931 [37] . However other authors [16,32,62] believe that Gowers may have been the fi rst to report this entity, although this tumor had an extramedullary location [28] . In a surgical series of more than 1 300 intramedullary tumors only 2 cases located in the spinal cord were encountered [71] ; other Zusammenfassung & Hintergrund: Intramedull ä re Tumoren betreffen einen kleinen, aber signifi kanten Teil von Patienten mit spinalen Tumoren.…”

“…In order to avoid the resulting confusion the term " spinal cord teratoma " should be used [2] . In a recent literature review Caruso reported 59 cases of intramedullary teratomas [16] . Using a Medline and literature search we were able to identify additional 9 patients.…”