Intradural Epidermoid Cyst at Conus Medullaris and Cauda Equina of the Spine: A Case Report

Shin, Minwoo; Lee, Jihae; Cho, Woo Ho; Kim, Jae Hyung; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Ji Young; Kim, Soo Hyun; Kang, Mi Jin; Cho, Hyun Sun; Lee, Han Bee

doi:10.3348/jksr.2012.66.2.113

Cited by 3 publications

(3 citation statements)

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“…This variability in signal characteristics, which might be related to the chemical state of cholesterol or the relative composition of cholesterol and keratin, makes preoperative diagnosis difficult 1) . Additionally, no contrast enhancement is seen in most cases, but enhancement of a thin peripheral rim has been reported 13) .…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Intraspinal Epidermoid Cyst

et al. 2014

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Epidermoid cyst is generally regarded as congenital disease, and commonly related to other congenital spinal anomalies. However, it also develops iatrogenically. We report one rare case of epidermoid cyst that we experineced among intradural extramedullary tumors. A 21-year-old female patient was admitted to the hospital due to low back pain with radiating pain into a right lower extremity that initiated about a month ago. She complained sensory lose and motor weakness (grade 4+) on her right extremity as well as urinary dysfunction and sphincter dysfunction. She had a lumbar puncture three times due to Pneumococcal meningitis when she was 13 years old. The well-circumscribed intradural extramedullary mass of 1.8×1.6×4 cm size was found on the L4-5 in a magnetic resonance image. Gross total tumor removal was garried out after the total laminectomy L5 and partial laminectomy L4. The tumor mass was gray-colored and so fragile that it was easy to be removed. The histological diagnosis confirmed epidermoid cyst without malignancy. After the operation, the patient progressively showed remarkable neurological recovery. In this case, the cause of epidermoid cyst is considered iatrogenic concerning history of several times of lumbar puncture as meningitis.

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Section: Discussionmentioning

confidence: 99%

Iatrogenic Intraspinal Epidermoid Cyst

et al. 2014

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“…analyzed the characteristics of the lumbar puncture material and concluded that it occurred due to poor lumbar puncture technique. [ 4 , 6 , 8 ] Choremis et al . presented six cases of epidermoid implantation cysts in children aged 7–12 years, who had undergone multiple lumbar punctures for the treatment of tubercular meningitis.…”

Section: Discussionmentioning

confidence: 99%

“…Although the epidermoid cysts are benign tumors, local recurrence (reported in up to 10–29% of cases) is reported, especially after subtotal excision because the incomplete excision of basal germinal cells. [ 5 , 8 , 9 ]…”

Section: Discussionmentioning

confidence: 99%

Intradural iatrogenic epidermoid cyst at cauda equina: A case report

Hernandez¹,

Anokwute

Martinez³

et al. 2020

Surgical Neurology International

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Background: Spinal epidermoid accounts for <1% of all primary spinal cord tumors. They occur due to the invagination of epidermal elements into the neural tube during the embryonic period. Even more infrequent are spinal epidermoid cysts that occur without attendant spinal dysraphism (e.g., as occurs with the iatrogenic inoculation of epithelial cells in the subarachnoid space following a lumbar puncture). Case Description: A 38-year-old female with a history of epidural spinal blocks at L2-3 for two previous pregnancies presented with low back pain, right lower extremity weakness (4/5 level), hyporeflexia, and tingling/ numbness in the right L3-5 distribution. The lumbar MR demonstrated an intradural extramedullary lesion at the L2-L3 level that compressed the cauda equina/nerve roots. MR findings were compatible with an epidermoid cyst, this was histologically confirmed following a microsurgical L2-3 laminectomy for lesion resection. Pathologically, the lesion demonstrated a keratinized stratified squamous epithelium with keratin content without cutaneous attachments, thus confirming the diagnosis of an epidermoid cyst. Postoperatively, her sensory complains improved and her motor strength fully recovered to the 5/5 level. Conclusion: Patients with spinal epidermoid cysts typically present with underlying spinal dysraphism, but only rarely do iatrogenic cases arise. Here, we presented a patient who developed a spinal lumbar epidermoid cyst in a female patient after undergoing spinal epidural anesthesia during pregnancy. Notably, this was successfully treated a with decompressive laminectomy and microsurgical resection.

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