Spinal intramedullary glioependymal cyst presented with paraplegia in an adult

Abstract

A 38 year old male patient presented with progressive weakness of both lower limbs with bladder and bowel dysfunction since last 1.5 months. On examination, bulk was normal, hypertonia was there in both lower limbs, power was 0/5 at hip, knee and ankle, deep tendon reflexes were brisk with patellar and ankle clonus present. Babinsky was present bilaterally and there was a loss of fine touch, crude touch, pain and temperature sensation below D12 level.Magnetic resonance image showed well defined cystic lesion of size 10mm × 8mm, present at D11-D12 level, appearing hypointense on T1W1 and hyperintense on T2W1 [ Figures 1 and 2]. Contrast study revealed smooth peripheral enhancement and perilesional edema from D8 to D12 level. During the surgery, D11-D12 laminectomy was done and dura opened in the midline. Adhesions were found between dura and cord. Midline dorsal myelotomy was done. An intramedullary, greyish white, partly cystic mass found, which was soft to firm in consistency, moderately vascular, nonsuckable and densely adhered to cord parenchyma. There was no definite plane of cleavage found between cystic mass and cord. Fenestration and decompression of the cyst was done and biopsy taken from the cyst wall [ Figure 3]. Dura was closed in a water tight fashion.