Dermoid tumors occurring at the site of previous myelomeningocele repair

Scott, R. Michael; Wolpert, S M; Bartoshesky, Louis; Zimbler, Seymour; Klauber, George T.

doi:10.3171/jns.1986.65.6.0779

Cited by 64 publications

(29 citation statements)

References 3 publications

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“…Van Gilder and Schwartz 13 produced dermoids experimentally in young rats by implantation of skin fragments. This theory was supported in human beings by other authors that reported the occurrence of such tumors secondary to implantation of dermal fragments into spinal subarachnoid space by accidental trauma 14 , lumbar puncture 15 or surgery 16 . Our case is interesting because the adult patient with chronic low back and leg pain and intestinal dysfunction presented with two distinct dermoids located at the lumbosacral region.…”

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

confidence: 71%

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

confidence: 71%

Concomitant dermoid cysts of conus medullaris and cauda equina

Falavigna

Righesso²,

Teles

2009

Arq. Neuro-Psiquiatr.

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“…2,5,12 They may occur with or without associated pathology (dysraphism or trauma) or by iatrogenic introduction during lumbar puncture. 1,7 They may also occur after operative procedures for spinal fracture associated with CSF leakage 10 and after operations for spinal dysraphism including repair of myelomeningocele, 9 lipomyelomeningocele, 11 and (exceptionally) with meningocele, 13 as in our patient. Epidermoids diagnosed in patients with prior spinal surgery can be related to either iatrogenic introduction of cells or underlying present ectodermal rests, particularly with a diagnosed meningocele, which carries an association with dermoid/epidermoid tumors.…”

Section: Postoperative Coursementioning

confidence: 98%

“…3,8 A series of these by Scott et al posits that dorsally located dermoids or epidermoids after myelomeningocele repair could be attributed to iatrogenic implantation of tissue, whereas the ventrally located tumors were a result of congenital dermal inclusions. 9 Symptomatic epidermoids are treated surgically. These histologically benign ectodermal rests may recur locally.…”

Section: Postoperative Coursementioning

confidence: 99%

Intramedullary spinal epidermoid presenting after thoracic meningocele repair: case report

Grobelny¹,

Weiner²,

Harter³

2015

PED

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A 4-year-old girl with a history of thoracic meningocele repair at the age of 3 months presented with progressive myelopathy. An intramedullary thoracic epidermoid was identified on MRI. The patient underwent excision of the epidermoid and subsequently returned to neurological baseline. This case illustrates the potential for delayed development of intraspinal epidermoid after initial repair of a simple meningocele.

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“…They may rupture spontaneously 4 by trauma, or during surgery 5 . Spinal dermoid tumours can be associated with bony malformations, myelomeningoceles, hypertrichosis and/or dermal sinus tract 6 .…”

Section: Discussionmentioning

confidence: 99%