Spinal epidermoid cyst with sudden onset of paraplegia

Munshi, Anusheel; Talapatra, Kaustav; Ramadwar, Mukta; Jalali, Rakesh

doi:10.4103/0973-1482.59913

Cited by 25 publications

(23 citation statements)

References 5 publications

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“…25 While the gradual onset of weakness has been described, Munshi et al reported sudden paraplegia in one patient due to inflammation following rupture of the epidermoid cyst, which produced serious symptoms and reduced quality of life. 26 Radical removal of the cyst and preservation of neurological function should be the goal of surgical intervention for spinal epidermoid and dermoid cysts. Because epidermoid and dermoid cysts grow through cisterns, the neural structures may be differentially involved.…”

Section: Discussionmentioning

confidence: 99%

Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region

Liu

Zhang

Zhu

2012

Journal of Clinical Neuroscience

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Section: Discussionmentioning

confidence: 99%

Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region

Liu

Zhang

Zhu

2012

Journal of Clinical Neuroscience

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“…It is suggested that incomplete excision of basal germinal cells of the tumor induce the tumor recurrence [3]. Because the tumor content includes fat and cholesterol, they may also produce an inflammatory reaction leading to meningitis [2, 4, 12, 15]. In our case, complete resection of the tumor’s capsule with emptying of the cyst material was achieved, although the tumor’s capsule ruptured during the procedure.…”

Section: Discussionmentioning

confidence: 70%

“…MRI is useful for the diagnosis of spinal ECs, demonstrating that the tumor is hypo-intense on the T1-weighted view and hyper-intense on the T2-weighted view. However, it is sometimes difficult to detect small cysts, because spinal ECs show the same signal as the cerebrospinal fluid on MRI [12, 13]. Myelography can also be performed to evaluate the deviation of the spinal cord, intradural filling defect, or the blocked subarachnoid space.…”

Section: Discussionmentioning

confidence: 99%

A rare case of intradural and extramedullary epidermoid cyst after repetitive epidural anesthesia: case report and review of the literature

et al. 2017

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BackgroundSpinal epidermoid cysts are benign tumors, which are rarely seen as an intradural extramedullary spinal cord tumor in the conus medullaris region. Acquired spinal epidermoid cysts are mostly caused by iatrogenic procedures, such as lumbar puncture, and the majority of acquired spinal epidermoid cysts have been reported below the L1 level, because lumbar puncture is usually performed around the iliac crest. Here, we report an extremely rare case of an epidermoid cyst that occurred as an intradural and extramedullary spinal cord tumor attached to the conus medullaris after repetitive epidural anesthesia.Case presentationA 67-year-old female presented with a low back pain and left sciatica. Although the patient had experienced occasional mild low back pain for several years, her low back pain markedly worsened 2 months before her visit, as well as newly developed left sciatica resulting in intermittent claudication. She had a history of several abdominal surgeries. All abdominal procedures were performed under general anesthesia with epidural anesthesia in her thoracolumbar spine. Magnetic resonance imaging of her lumbar spine demonstrated an intradural extramedullary spinal cord tumor at the T12–L1 level. Because her symptoms deteriorated, the tumor excision was performed using microscopy. Histological examination of the specimens demonstrated that the cyst walls lined with stratified squamous keratinizing epithelium surrounded by the outer layer of collagenous tissue with the absence of skin adnexa. A diagnosis of epidermoid cysts was confirmed. Her MRI showed complete resection of the tumor, and there was no recurrence at 2-year follow-up.ConclusionsIn this case report, epidermoid cells might be contaminated into the spinal canal during repetitive epidural anesthesia. The patient was successfully treated by complete resection, and there was no recurrence at 2-year follow-up with a good clinical outcome. However, long-term follow-up is required for a potential risk of tumor recurrence.

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“…X-rays often show a normal image and CT can only display the location and outline of the tumor. On MRI, the tumor is usually isointense or hypointense in T1-weighted images and hyperintense in T2-weighted images and the cyst content has the same signal as the cerebrospinal fluid [17-19]. But these signal characteristics are not always constant and some variations have been reported in the literature [18,20,21].…”

Section: Discussionmentioning

confidence: 99%

“…So subtotal excision tends to be the more common surgical pattern for avoiding possible neural damage [10,18,19,22,23,30]. Subtotal excision also causes great distress for patients and doctors because debris from the tumor may cause an early relapse of symptoms and the spread of cyst contents can cause foreign body reactions and severe complications [2,17,19,23,28,29]. …”

Section: Discussionmentioning

confidence: 99%

Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine

Yin

Zhang

et al. 2014

World J Surg Onc

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Study designThis was a retrospective study.ObjectiveThe aim of this study was to analyze the clinical characteristics and discuss the treatment options for epidermoid cysts in the lumbar spine.Summary of background dataEpidermoid cysts are rare benign neoplasms, which account for less than 1% of all intraspinal tumors. Due to their rarity, there are only a few case reports in the literature. Complete excision is the recommended treatment for an epidermoid cyst, but this is difficult to achieve in the spine. In spite of their benign nature, local recurrence is not uncommon for spinal epidermoid cysts after incomplete excision.MethodsSix patients with an epidermoid cyst in the lumbar spine underwent surgical treatment in our center between 2004 and 2011. A total excision using microsurgical techniques and reconstruction was successfully undertaken in all patients. Clinical data and detailed pathologic results were retrospectively analyzed. All cases were followed up for a median time of more than 4 years. The clinical data and surgical efficacy were analyzed to suggest treatment options for epidermoid cysts in the lumbar spine on the basis of a literature review and our own experience.ResultsThe mean age of the patients in this study was 37.7 years and the mean duration of pre-operative symptoms was 29.7 months (2 to 120 months). All patients were disease-free during their follow-up period. Radicular pain nearly disappeared, and patients suffering from neurologic deficits and defecation disorders recovered well.ConclusionsAlthough an epidermoid cyst is a benign tumor, it is apt to recur locally following inadequate removal. Therefore, complete excision with preservation of neural function is an ideal protocol for intraspinal epidermoid cysts. Microsurgical techniques are very useful.

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Spinal epidermoid cyst with sudden onset of paraplegia

Cited by 25 publications

References 5 publications

Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region

Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region

A rare case of intradural and extramedullary epidermoid cyst after repetitive epidural anesthesia: case report and review of the literature

Surgery and outcomes of six patients with intradural epidermoid cysts in the lumbar spine

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