Isolated central canal rupture of spinal dermoid: Report of two cases

Garg, Ajay; Gupta, Vipin Kumar; Gaikwad, Shailesh; Deol, P.S.; Suri, Ashish; Kale, Shailaja

doi:10.1046/j.0004-8461.2003.01152.x

Cited by 17 publications

(21 citation statements)

References 14 publications

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“…Scearce et al 14) reported that fat droplets reach the ventricles from the perimedullary subarachnoid space via retrograde flow through the foramina of Luschka and Magendie. To the best of our knowledge, few cases of ruptureed mature teratoma have been reported 2,5,6,8,14) . In our case, the mature teratoma appeared to have ruptured spontaneously with the intracranial dissemination of fatty droplets.…”

Section: Discussionmentioning

confidence: 99%

Surgical Findings of a Lumbar Mature Teratoma Accompanying the Preoperative Intracranial Dissemination of Fatty Droplets

Kim

et al. 2009

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 46 : [409][410][411][412] 2009 There are several mechanisms for the dissemination of lipid material from a mature teratoma into the subarachnoid space or ventricles, including iatrogenic or traumatic rupture, but spontaneous rupture of a mature teratoma is rare. We report the spontaneous rupture of a spinal mature teratoma into the subarachnoid space and ventricles. However, at surgery, there was no definite evidence of rupture into the perimedullary cerebrospinal fluid. We postulate that the central canal could be a migration pathway for ruptured material into the brain.

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Section: Discussionmentioning

confidence: 99%

Surgical Findings of a Lumbar Mature Teratoma Accompanying the Preoperative Intracranial Dissemination of Fatty Droplets

Kim

et al. 2009

J Korean Neurosurg Soc

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“…These cases may present with hydrocephalus, meningitis, spinal arachnoiditis or be asymptomatic 3,5 . The rupture can be spontaneously, posttraumatic or postoperatively 3,5 . It is possible that, in the case presented, the large extramedullary tumor of the cauda equine might have ruptured and implanted at the conus medullaris.…”

Section: Fig 3 Histological Analysis Of the Specimens [A] Abundant mentioning

confidence: 99%

“…The patient had no history of spinal manipulation or trauma and any sign of dysraphism on physical and image exams. Its known that spinal dermoid cysts can rupture, and their content can spread throughout the subarachnoid space and ventricular system 3,5 . These cases may present with hydrocephalus, meningitis, spinal arachnoiditis or be asymptomatic 3,5 .…”

Section: Fig 3 Histological Analysis Of the Specimens [A] Abundant mentioning

confidence: 99%

“…Its known that spinal dermoid cysts can rupture, and their content can spread throughout the subarachnoid space and ventricular system 3,5 . These cases may present with hydrocephalus, meningitis, spinal arachnoiditis or be asymptomatic 3,5 . The rupture can be spontaneously, posttraumatic or postoperatively 3,5 .…”

Section: Fig 3 Histological Analysis Of the Specimens [A] Abundant mentioning

confidence: 99%

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Concomitant dermoid cysts of conus medullaris and cauda equina

Falavigna

Righesso²,

Teles

2009

Arq. Neuro-Psiquiatr.

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Spinal dermoid cysts are benign tumors that results from congenital or adquired ectodermal inclusions [1][2][3][4][5][6][7] . Histologically they are characterized by the presence of dermal structures. These tumors account for 0.8%-1.1% of all primary spinal tumors with the majority occurring in the extramedullary or subdural juxtamedullary lumbosacral region, usually in the conus or cauda equina 1,7 . In the pediatric population, the prevalence of dermoid tumors is much greater, with dermoids accounting for 5% to 17% of all intradural lesions in reported series 1,2,6 . A higher incidence of dermoid cysts has been described in patients with spina bifida, dermal sinuses, myelomeningocele, hemi-vertebrae and syringomyelia [1][2][3][4]6,7 . We present a rare case of an adult woman who presented with two separated dermoid cysts in the cauda equina and conus medullaris. The literature concerning to dermoids is also reviewed focusing on the tumor etiopathogenesis. CASEA 35-year-old woman presented with chronic low back pain and left ciatalgia. She had previous history of two abdominal surgeries to the treatment of chronic constipation with intraoperative diagnosis of intestinal adherences. No history of spinal trauma, surgery or lumbar puncture was reported. She brought a normal lumbar radiography. Neurological examination revealed hypoesthesia in the lateral surface of the left leg, weakness on dorsiflexion of the left foot and Lasègue sign on the left leg. The magnetic resonance imaging (MRI) evidenced a large mass located at cauda equina and a smaller mass located at the conus medullaris (Fig 1).Surgical resection was accomplished through a posterior midline incision exposing L2 to S2. Dissection and lateral removal of musculature were performed followed by laminectomy from L3 to S1. There was a decrease of the epidural fat and the dural sac was hypertense and non-pulsatil. After opening the dura mater a large brown-yellowish tumor was observed tightly adhered with cauda equina nerves (Fig 2A). Microscopically total tumor removal was accomplished with normal nervous margins ( Figs 2B and 2C). A small fragment of the intradural conus tumor was resected and then the remaining tumor was excised by aspiration with the ultrasonic aspirator. The surgical time was 2.5 hours and the bleeding was 650 mL.The histological examination of the tumors in cauda equina and conus yielded a diagnosis of dermoid cysts (Fig 3). Postoperatively, the patient had urinary retention which reverted in two months. Follow-up at four years showed complete resolution of preoperative symptoms, including constipation, and no evidence of local or systemic recurrence.

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Symptomatic central canal rupture heralding the presence of an asymptomatic conus dermoid

et al. 2007

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Dermoid cysts represent a rare group of tumors manifesting predominantly in adulthood. Rupture of these tumors is well described with it being symptomatic more commonly intracranially as compared to central canal rupture of intraspinally located dermoid tumor which not only is uncommon, but also frequently asymptomatic. The authors report an unusual case of asymptomatic conus dermoid in a young male diagnosed when investigated for a symptomatic isolated central canal rupture. Fatty contents within the central canal may be a harbinger of an underlying dermoid tumor and a whole spine MRI should be performed in such cases to rule out this bizarre presentation.

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Isolated central canal rupture of spinal dermoid: Report of two cases

Cited by 17 publications

References 14 publications

Surgical Findings of a Lumbar Mature Teratoma Accompanying the Preoperative Intracranial Dissemination of Fatty Droplets

Surgical Findings of a Lumbar Mature Teratoma Accompanying the Preoperative Intracranial Dissemination of Fatty Droplets

Concomitant dermoid cysts of conus medullaris and cauda equina

Symptomatic central canal rupture heralding the presence of an asymptomatic conus dermoid

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