Unusual origin of free subarachnoid fat drops: a ruptured spinal dermoid tumour

Barsi, Péter; Kenéz, J; Várallyay, György; Gergely, L

doi:10.1007/bf00588199

Cited by 26 publications

(29 citation statements)

References 7 publications

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“…The onset is usually insidious or due to mass lesion but sometimes there are acute meningitic complaints or increased intracranial pressure as a result of cyst rupture and spillage of the irritative contents into the subarachnoid space. Fatty droplets within the ventricular system and subarachnoid space have been reported in many cases, but fat particles in the dilated central spinal canal were reported in only a few cases and are unexpected (1,2,6). Fatty contents within the syrinx cavity may be a sign of an underlying dermoid or epidermoid tumor and a whole spine and cranial magnetic resonance imaging (MRI) should be performed in such cases.…”

Section: Introductionmentioning

confidence: 99%

A spinal dermoid cyst that spontaneous ruptured into the syrix cavity: a case report

Özsoy

Ökten²,

Arslan³

et al. 2012

Turkish Neurosurgery

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Dermoid cysts are rare benign congenital tumors comprising 1.1 % of the spinal tumors, with lumbosacral region and cauda equina being the common sites. Many cranial cases with spillage of cyst contents into the subarachnoid space have been reported. We report an extremely unusual case of symptomatic spinal dermoid cyst that ruptured into the syrinx cavity. The gold standard treatment is complete resection of both cyst wall and content in dermoid cysts. However, there is no consensus for the treatment of the syrinx cavity. Observation of similar cases would give us more information about treatment options and the progression of these lesions. KeywoRds: Dermoid cyst, Spinal tumor, Syrinx cavity ÖZDermoid kistler nadir, iyi huylu sıklıkla lumbosakral ve kauda equina bölgelerinde görülen, spinal tümörlerin %1,1'ini oluşturan konjenital tümörlerdir. Kist içeriğinin subaraknoid mesafeye yayılması literatürde kraniyal olgularda oldukça sık karşılaşılır. Biz oldukça nadir görülen sirinks kavitesine açılmış semptomatik bir spinal dermoid olgusunu sunduk. Dermoid kistlerde altın standart tedavi, kist duvarının ve içeriğinin çıkartılmasıdır fakat sirinks kavitesinin tedavisi ile ilgili bir fikir birliği yoktur. Benzer olguların incelenmesi bize bu olguların tedavi seçenekleri ve ilerleyişleri hakkında bilgi verecektir.

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Section: Introductionmentioning

confidence: 99%

A spinal dermoid cyst that spontaneous ruptured into the syrix cavity: a case report

Özsoy

Ökten²,

Arslan³

et al. 2012

Turkish Neurosurgery

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“…They are associated with intraventricular fat/ cerebrospinal fluid levels, with generalised and localised subarachnoid spread of the contents of the dermoid cyst [3]. Ruptures of teratomas [4,5] and intraspinal dermoids [6] have also been implicated as a source of subarachnoid fat-attenuation droplets. One case report described the dissemination of fat particles in the basal cisterns and frontal horns of the lateral ventricles following removal of a foramen magnum meningioma [7].…”

Section: Discussionmentioning

confidence: 99%

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear

Woo

Malfair²,

Vertinsky³

et al. 2010

BJR

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ABSTRACT. We present the case of a 28-year-old man with an unusual aetiology of lipid-dense material in the subarachnoid space. CT of the head at presentation was normal. MRI of the spine revealed a defect in the dura at L5/S1, with avulsed left L5 and S1 nerve roots. Haematoma and marrow fat were observed in close relation to the dural tear adjacent to the sacral fracture. Head CT and MRI subsequently demonstrated new lipid-dense material and haemorrhage in the subarachnoid space after sacral instrumentation, presumably owing to transthecal displacement of fatty marrow. The presence of fat droplets within the subarachnoid space is an unusual finding and is most commonly the sequelae of a ruptured dermoid. We present a unique case with CT and MRI that demonstrates the development of subarachnoid fat emboli and subarachnoid haemorrhage secondary to pelvic trauma. A sacral fracture with an adjacent dural tear and nerve root avulsion is the putative source of the subarachnoid fat and blood. Case reportA 28-year-old man presented to the emergency room after being struck by a high-speed vehicle as a pedestrian. He suffered multiple orthopaedic injuries, including an open-book pelvic fracture as well as upper and lower extremity fractures. Pertinent physical examination findings included the absence of left ankle dorsiflexion, plantar flexion, inversion and eversion. An absence of light touch and pinprick sensation in the left L5 and S1 dermatomes was also noted.At presentation, CT of the head did not demonstrate any calvarial or skull base fracture or other intracranial abnormalities (Figure 1a). Specifically, neither subarachnoid haemorrhage nor subarachnoid fat droplets were present. CT of the pelvis demonstrated a transforaminal left sacral fracture and superior and inferior left pubic rami fractures. A mixed fat and blood attenuation collection was also seen within the left aspect of the thecal sac at the L5/S1 level. Fixation of the sacral fracture, with the placement of an iliosacral screw, was performed shortly after initial imaging.Three days post-trauma, repeat CT of the head was performed because of a decreased level of consciousness.Small supernatant globules of fat (2124 Hounsfield units (HU)) were identified in the subarachnoid space in the prepontine cistern (Figure 1b), frontal horns of the lateral ventricles and foramen magnum. Intraventricular blood and subarachnoid haemorrhage in the interpeduncular fossa were also seen. A CT angiogram from the aortic arch to the vertex revealed no evidence of traumatic dissection, aneurysm or vascular malformation that would explain the presence of the new subarachnoid haemorrhage. MRI of the brain performed the same day confirmed the presence of subarachnoid and intraventricular fat and haemorrhage (Figure 2a,b). The MR study also showed several T 2 /FLAIR (fluid-attenuated inversion-recovery) hyperintensities in the cerebral white matter, as well as in the splenium of the corpus callosum, in keeping with diffuse axonal injury.MRI of the post-operative lumbosacral...

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“…1,4 To date, few authors have described the occurrence of dysembryogenetic spinal lesions in adults. 2,3,5,6 The following case of mature spinal cystic teratoma was found in an 85-year-old patient. The unique pathogenesis of these lesions, neuroimaging modalities, pathologic findings, and treatment options are reviewed.…”

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confidence: 96%

“…Even less common are patients who initially present in adulthood. [1][2][3][4][5][6] These lesions include epidural, intradural intramedullary, and intradural extramedullary tumors. They include, but are not limited to, cystic teratomas, enterogenous cysts, and dermoid and epidermoid cysts.…”

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confidence: 99%

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Intradural Extramedullary Mature Cystic Teratoma

Stevens

Kattner

Chen

et al. 2006

Journal of Spinal Disorders &Amp; Techniques

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The occurrence of cystic teratomas in the absence of previous surgery or lumbar puncture is uncommon. Even rarer are reports of these lesions in aged patients. Of particular interest in this case is the fact that this patient had not undergone any previous lumbar procedures nor did he have a history of spinal dysraphism. Though rare, this entity should be included in the differential of cystic intradural spinal cord lesions.

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Unusual origin of free subarachnoid fat drops: a ruptured spinal dermoid tumour

Cited by 26 publications

References 7 publications

A spinal dermoid cyst that spontaneous ruptured into the syrix cavity: a case report

A spinal dermoid cyst that spontaneous ruptured into the syrix cavity: a case report

Intracranial transthecal subarachnoid fat emboli and subarachnoid haemorrhage arising from a sacral fracture and dural tear

Intradural Extramedullary Mature Cystic Teratoma

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