Dermoid cyst: A rare intramedullary inclusion cyst.

Department of Neurosurgery, Baroda Medical College and SSG Hospital, & Neurosurgical Hospital, Vadodara, Gujarat, India.
Asian journal of neurosurgery 04/2012; 7(2):81-3. DOI: 10.4103/1793-5482.98651
Source: PubMed

ABSTRACT Intramedullary dermoid cysts are rare tumors, especially those not associated with spinal dysraphism. Only six cases have been reported in the literature. Of these, only two cases have had magnetic resonance imaging studies. We report a case of an 18-year-old female patient, who presented with progressive weakness of both the lower limbs and wasting of both the upper limbs. Magnetic resonance imaging (MRI) showed an intramedullary lesion extending from C3 to D2 with peripheral enhancement on contrast. Decompression of the cystic contents with partial removal of cyst wall was done. Hair with oily cholesterol and keratin debris was encountered. Histopathology confirmed the diagnosis of dermoid cyst. This case adds to the previous reported cases of the rare and uncommon intramedullary space occupying lesions of the spinal cord.

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    ABSTRACT: A 65-year-old male was admitted because of 2-month history of left arm weakness. Spinal MRI showed a cervical intramedullary lesion whose features suggested a dermoid cyst (Fig. 1 a, b). No spinal dysraphisms were evident. At operation (under neurophysiological monitoring), after a C2–C5 laminotomy, dural opening and myelotomy, the lesion appeared composed of two components: cranially the cyst was filled with caseous yellowish and pearly material which was removed; caudally the lesion presented calcified material which was only partially removed because it was very adherent to the surrounding neural tissue (Fig. 1 c, d). Post-operative course was characterized by worsening of left arm weakness and onset of moderate weakness of legs. Histological examination confirmed the presence of keratin debris and bone suggesting a diagnosis of dermoid cyst.Fig. 1Spinal MRI showing the lesion composed by a dishomogeneous cranial portion hyperintense on T1-weighted images (a) and a caudal one mostly
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    ABSTRACT: BACKGROUND: Intraspinal dermoid cysts are rare and benign tumors that occur primarily due to the defective closure of the neural tube, an ectodermal derivative, during the process of development. They are slow-growing tumors manifesting in the second and third decades of life. CASE PRESENTATION: We present here a case of a 14-year-old Sindhi boy with a six-month history of paraparesis of the lower limbs and a progressive loss of power of grade 3/5, and hypoesthesia in the L4/L5 dermatomes of his right lower limb. A plain magnetic resonance imaging scan revealed a well-demarcated intraspinal intramedullary cyst containing an abscess at the level of T12 and L1 causing localized cord compression, which was producing the symptoms. Near total excision of the cyst was successfully performed and was sent for biopsy, which revealed keratinocytes and keratin flakes. With one month of follow-up, along with physiotherapeutic management, the patient gradually improved and was able to walk without support. CONCLUSIONS: Critical evaluation of every case with aggravating symptoms should be carried out, and neurological and radiological examinations should be conducted to ensure the well-being of patients.
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    ABSTRACT: Intramedullary dermoid cyst is a type of rare congenital intraspinal lesions. Its proximity and its strong adherence to the surrounding spinal cord tissue often make a complete resection of the cyst wall problematic. We retrospectively studied five cases of intramedullary dermoid cyst, focusing the recurrence of intramedullary dermoid cyst after surgery and the probable method to prevent the recurrence. Five cases of intramedullary dermoid cyst with or without other concomitant deformities were retrospectively reviewed. Subjects consisted of three males and two females, aged 2-24 years. Diagnosis was confirmed by spinal MRI and pathology studies. Surgical outcomes were analyzed. In case 2, an Ommaya reservoir was implanted in the cystic cavity, and the cystic content was sucked though the Ommaya reservoir. An 18-113 months of follow-up was conducted. The contents of intramedullary dermoid cyst were loose and easy to be cleared in the operations. The cyst wall was closely adhered to the spinal cord, and complete resection was difficult. During the follow-up of 18-113 months, the lesion reoccurred in three cases. Intramedullary dermoid cyst is prone to recurrence. The presence of residual cyst wall might be the cause of dermoid cyst recurrence. When a complete resection of cyst wall becomes infeasible, placement of an intraspinal Ommaya reservoir may help to delay and minimize clinical symptoms by aspiration of cystic contents in case of recurrence.
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