Dermoid cyst: A rare intramedullary inclusion cyst

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.     

Concomitant cervical and lumbar intradural intramedullary lipoma

BACKGROUND: Lipomas of the spinal cord are often a component of spinal dysraphic states. Nondysraphic intramedullary spinal cord lipomas are rare, and concomitant isolated cervical and lumbar intradural intramedullary lipomata are very rare. One patient with concomitant isolated nondysraphic cervical and lumbar spinal cord lipomata has been reported and management options discussed. CASE DESCRIPTION: A young girl presented with insidious-onset diffuse neck pain and early myelopathic signs. Conventional radiographs were normal. Magnetic resonance imaging of the whole neuraxis revealed concomitant cervical and lumbar intradural intramedullary lipoma. Subtotal resection of the lesion was performed at both levels, after which the patient improved symptomatically and was ambulant independently. CONCLUSION: Concomitant intradural lipomas at 2 different locations unassociated with a dysraphic state is very rare. Magnetic resonance imaging with fat suppression study is the investigation of choice. Adequate decompression with subtotal removal is the treatment of choice.     

Cervicobulbar intramedullary lipoma

Background contextSpinal lipomas not associated with spinal dysraphism are rare entities. Further, large medullary lipomas with intracranial extension are occasionally described. Most of the intradural lipomas are subpial and not really intramedullary.PurposeClinicians may be made aware of such a rare entity and its presentation.Study design/settingAn extremely rare case of medullary lipoma extending into posterior fossa is described in an adult, not associated with spinal dysraphism.MethodsA young male presented with high cord myelopathy in the form of spastic quadriparesis. Radiological investigations revealed dorsally placed intramedullary lipoma extending into posterior fossa.ResultsSurgical excision of tumor provided satisfactory resolution of symptoms.ConclusionsMedullary lipomas may present with features of high cord compression and myelopathy. Magnetic resonance imaging remains the investigative and follow-up modality of choice. Even when total tumor excision is not feasible, subtotal removal and decompression provides long lasting symptom-free survival.     

Long segment spinal intramedullary dermoid cyst: A case report

IntroductionSpinal intramedullary dermoid is very rare, accounting for <1% of intraspinal tumors. It can be congenital or acquired. They usually present in 2nd or 3rd decade of life in adults. It may or may not associated with spinal dysraphism. It is asymptomatic in most cases, manifest acutely if it ruptures.Long segment involvement of spinal intramedullary tumor in adult without the history of trauma makes this case unique. Fat suppression imaging helps to distinguish adipose tissue from lesions causing hematomyelia in patients presented with intramedullary hyperintensity in both T1 & T2 sequences of MRI spine.Case presentationWe report here a rare case of 30 years old male who presented to us with sudden urinary retention followed by rapidly progressive quadriparesis and paresthesia in his right arm. In MRI, spinal intramedullary tumor was noted from medulla till D5 vertebra. We performed subtotal excision of tumor and sample sent for histopathology which proved it to be intramedullary spinal dermoid cyst.ConclusionLong segment involvement of spinal intramedullary dermoid cyst in adult without history of trauma makes this case different. Fat suppression imaging must be done in patients with intramedullary hyperintensity in both T1 and T2 sequences of MRI spine. Early diagnosis and appropriate management will be helpful in reducing morbidity.     

Non-dysraphic intramedullary spinal cord lipoma

True intramedullary spinal cord lipomas are extremely rare. Two cases of intramedullary spinal cord lipoma are presented. The patients did not exhibit any form of spinal dysraphism. The patients presented with gait difficulty, upper limb weakness, sphincter disturbance, dysesthesias and neck pain. The tumors were removed sub-totally and the neurological grade improved postoperatively in one of the patients.     

Non-dysraphic intramedullary spinal cord lipoma. A case report

Non-dysraphic spinal cord lipomas are rare benign lesions, accounting for approximately 1% of all spinal cord tumors. Patients usually present with long histories of disability followed by rapid progression of their symptoms. Presenting symptoms include spinal pain, dysesthesic sensory changes, gait difficulties, weakness, and incontinence. Magnetic resonance imaging is the examination of choice. The T1- and T2-weighted images show increased and decreased signal intensity, respectively. The goal of intervention is decompression and generous debulking following by duraplasty. Early diagnosis of spinal cord lipomas and early surgery is advanced prior to irreversible disease progression. One new case of true non-dysraphic cervicodorsal spinal cord lipoma is reported.     

Growth of intramedullary lipoma in a renal transplant recipient

BACKGROUND: Administration of glucocorticoids can lead to a variety of complications in addition to deposition of fat leading to cushingoid features. Corticosteroids, either endogenously produced or exogenously administered, are implicated in the growth of lipomas in different anatomic locations including the epidural space in the spinal cord causing cord compression. METHOD: We report a growth of lipoma in an unusual site in a 28-year-old female renal transplant recipient within 6 weeks of renal transplant surgery. RESULT: Our patient had an intradural lipoma that had merged with the medulla of the spinal cord making its total excision unfeasible without damaging the spinal cord. CONCLUSION: Epidural lipomas causing cord compression is documented in patients receiving long-term corticosteroid therapy. This is the first case of intramedullary lipoma of the spinal cord that may be related to steroid use.     

Coexistence of spinal intramedullary teratoma and diastematomyelia in an adult

STUDY DESIGN: A case report of intramedullary spinal cord teratoma with remote diastematomyelia in a female adult. OBJECTIVE: To present a rare case of a dysembryogenic spinal tumor with concurrent split cord malformation and to define the importance of early surgical removal of the tumor. SETTING: A department of neurosurgery in Greece. METHODS: A 44-year old woman, presented with progressive lower limb muscle weakness, gait disturbances and dysesthesias in the trunk and lower extremity. She underwent plain radiographs, CT and MRI scan, which revealed an exophytic intramedullary spinal cord tumor at the level of T8-T10 and distant diastematomyelia in the upper lumbar spine (L2-L3). She underwent surgical intervention. The tumor was subtotally removed. No attempt was made to treat diastematomyelia. RESULTS: Postoperatively, the patient's neurological status started to improve gradually. After 1 year she exhibited better strength in the lower limb muscles and improved sensation. The histological examination demonstrated mature spinal teratoma consisting of ectodermal, mesodermal and endodermal elements. CONCLUSIONS: In adult patients with intramedullary masses of possible dysembryogenic origin, the whole spine must be examined for additional dysraphic lesions. The choice and the timing of a surgical intervention are strongly dependent on the clinical picture.     

Non-dysraphic intramedullary spinal cord lipoma of the child: Report of 3 cases

Background and purposeNon-dysraphic intramedullary spinal cord lipomas (NDSCL) represent 1% of spinal cord tumors. They are less frequent than dysraphic spinal cord lipomas and clinical presentation is unspecific. There are no guidelines on surgical management.Material and methodsWe report three observations of NDSCL in children, focusing on the clinical presentation, surgical management and postoperative outcome.ResultsThe patients, one female and two males, aged from 5 months to 10 years presented with neurological deterioration, pain, spinal rigidity and in two cases, a subcutaneous mass. Spinal MRI found intradural lipomas without spina bifida, located in the cervico-thoracic area in all cases. The lipoma extended to the medulla oblongata in two cases and was in the lumbar region in the third. These lipomas were massive, requiring decompression surgery. Surgery confirmed the lipoma to be subpial. We performed debulking of the lipoma without attempting total resection, and with or without dural plasty and laminoplasty, followed by minerva cast in two cases, and avoidance of standing in the youngest. Satisfactory recovery occurred in all three cases. After a follow-up between 4 months and 9 years, the outcome was favorable in all cases, and no patient presented with secondary spinal deformation or lipoma progression.ConclusionNDSCL is a rare entity, which often manifests with progressive pain and neurological deficits. In our experience, partial resection with or without dural plasty and laminoplasty has been associated with satisfactory postoperative outcomes and no recurrence of symptoms. We should be attentive to the risk of postoperative spinal deformity in these young patients.     

Anterior approach to intramedullary hemangioblastoma: case report

OBJECTIVE AND IMPORTANCE: Intramedullary spinal cord tumors are generally operated on by using the posterior approach. However, the posterior approach may not be suitable for a tumor in the anterior part of the spinal cord. In this report, we describe a case of a cervical intramedullary tumor that was successfully removed by using the anterior approach. CLINICAL PRESENTATION: A 48-year-old woman presented with lower cranial nerve disturbance and motor weakness of the upper extremities. Magnetic resonance imaging revealed a large extensive syrinx and an intramedullary enhanced tumor at the C6 level. The tumor was located at the left of the anterior part of the spinal cord. INTERVENTION: Based on these findings, the anterior approach was used in performing a corpectomy of C5 and C6. The tumor was highly vascular and was resected without resulting in any operative deficits. The pathological diagnosis was hemangioblastoma. CONCLUSION: The present case suggests that the anterior approach is an important option among surgical approaches to the intramedullary tumor in cases in which the tumors are small in size and are located in the anterior part of the cervical cord.     

Cervicobulbar intramedullary lipoma. Apropos of a case with review of the literature]

The authors report a case of cervical intramedullary lipoma extending into the bulbomedullary junction. 99 cases of cervical and/or dorsal intramedullary lipomas without spinal dysraphism, reported since 1884, are reviewed. There is poor correlation between lipoma's length and age of onset. Only lipoma extended to all the spinal cord begin in the first years of life. Clinical presentation is in 58% of cases a slowly compressive myelopathy, a syringomyelic syndrome in 9.5% of cases, a Brown Sequard syndrome in 6.5% of cases or atypical clinical features in 26% of patients. Finding of a subcutaneous lipoma at the level of the lesion helps for diagnosis. C.T. scan and magnetic resonance imaging (M.R.I.) precise lipomatous constitution of the tumor, its limits and relations with neighbouring tissues. Surgery is necessary when clinical features are advanced. Surgery indication is debatable when neurological manifestations are poor or absent. Post operative course is generally good and is not related with type of intervention.     

Dorsal intramedullary spinal epidermoid cysts: Report of two cases and review of literature

Intramedullary epidermoid cysts of the spinal cord are rare tumors, especially those not associated with spinal dysraphism. About 50 cases have been reported in the literature. Of these, only seven cases have had magnetic resonance imaging (MRI) studies. We report two cases of spinal intramedullary epidermoid cysts with MR imaging. Both were not associated with spina bifida. In one patient, the tumor was located at D4 vertebral level; while in the other, within the conus medullaris. The clinical features, MRI characteristics and surgical treatment of intramedullary epidermoid cyst are presented with relevant review of the literature.     

Cervical intradural extramedullary cavernoma presenting with isolated intramedullary hemorrhage

Among cavernomas of the central nervous system, spinal ones are rare. The true incidence of spinal cavernomas is unclear, but with widespread use of magnetic resonance imaging the number of cases is increasing. Furthermore, cavernomas represent only 5-12% of all vascular anomalies of the spinal cord, with a mere 3% reported to be intradural and intramedullary in location. Cervical spine intradural extramedullary cavernomas are very seldom seen, and only 4 cases have been reported in world literature previously. In this report, a unique case of an intradural extramedullary spinal cavernoma was surgically treated in a patient who presented only with an intramedullary hemorrhage.     

Primary intramedullary primitive neuroectodermal tumor of the cervical spinal cord. Case report

Primary intramedullary primitive neuroectodermal tumors (PNETs) of the spinal cord are rare. Only six cases have previously been reported, all involving tumors in the thoracic or lumbar spine. The authors report the case of a 54-year-old woman who presented with quadriplegia and bladder and bowel dysfunction. The patient had suffered symptoms of neck pain for 1 month and left shoulder weakness for 10 days. Magnetic resonance imaging of the cervical spine revealed an intramedullary mass extending from C-2 to C-5 with an exophytic component in the adjacent left subarachnoid space. Multiple biopsy specimens were obtained, and a partial excision was performed. Histological examination revealed nodular growth and neuronal differentiation, with a striking resemblance to desmoplastic medulloblastoma. A positron emission tomography scan did not reveal uptake at any site. These findings confirmed the diagnosis of a primary intramedullary PNET. Postoperatively, the patient was given craniospinal radiotherapy with a radiation boost to the tumor bed.     

Giant bipolar intramedullary nondysraphic spinal cord lipoma: A case report

Introduction

Intramedullary spinal cord lipomas (IMSCL) are a rare entity, accounting for less than 1% of spinal tumors. Most cases are associated with lumbosacral dysraphism and occur predominantly in the pediatric population.

Magnetic resonance imaging in cases of spinal dural arteriovenous malformation

Two patients with spinal dural arteriovenous malformations associated with intramedullary changes confirmed by the T2-weighted magnetic resonance imaging (MRI) scans are reported. The characteristics of the MRI findings for these 2 patients were as follows. 1) In the T2-weighted spin-echo image, intramedullary changes observed by MRI were visualized as a high signal intensity area at the level where delay in venous circulation of the spinal cord was revealed by the angiography of the spinal cord. 2) After the obliteration of the arteriovenous shunt by surgical management, intramedullary changes remarkably decreased and disappeared with the disappearance of swelling of the spinal cord observed preoperatively. After that, the atrophy of the spinal cord was shown. 3) The level, extent, and severity of intramedullary changes were decided by the condition of the level where the radiculospinal vein, as the flowing vein, refluxes into the coronal venous plexus and venous flow occurs through the radiculospinal vein into the epidural veins. We suspect that intramedullary changes shown by the T2-weighted MRI scan chiefly represent edema of the spinal cord, caused by an increase in venous pressure due to venous congestion of the spinal cord. MRI is a very useful diagnostic aid to detect intramedullary changes associated with a spinal dural arteriovenous malformation and to evaluate therapeutic results after surgery.     

Lumbosacral intramedullary myolipoma. Case report

Intradural myolipoma is an unusual tumor. A case is described in which extramedullary and intramedullary striated muscle fibers caused gross contraction of a lipomatous tumor as well as of the spinal cord during electrical stimulation.     

Intramedullary lipoma of the cervicodorsal spinal cord with intracranial extension: case report

BACKGROUND: An unusual case of an extensive intramedullary lipoma of the cervicodorsal spinal cord with intracranial extension causing compression of spinal cord and brainstem is described. CASE DESCRIPTION: A 3-year-old child with lack of limb movement since birth, the cause of which had remained obscure, developed opisthotonos and episodes of severe respiratory difficulty with brief periods of apnea. Craniospinal computed tomography and magnetic resonance imaging (MRI) were diagnostic of lipoma. Urgent occipitocervical decompression and subtotal removal of the posterior fossa and cervical spinal cord lipoma resulted in lasting resolution of symptoms. CONCLUSIONS: Extensive spinal cord lipomas with intracranial extension can present with alarming spinal cord/medullary compression and respiratory symptoms. Computed tomographic scan and MRI are diagnostic. Total removal is not feasible, or necessary, because subtotal removal and decompression give long-lasting resolution of symptoms.     

Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus.

Intramedullary spinal abscesses are rare and potentially devastating lesions. A heightened clinical awareness of patients at risk is essential for an early diagnosis and intervention to improve the prognosis of these patients. The first case of spinal abscess was described in 1830, and only 63 cases have been reported subsequently. Intraspinal epidermoids also are unusual lesions. These tumors were reported first in 1829 and represent less than 1% of all intraspinal tumors. We present a case of a 2-year-old girl who had rapidly progressive paraplegia with urinary and bowel retention and was found to have an intramedullary epidermoid and an intramedullary abscess as a result of a dermal sinus. The association of an intramedullary abscess and epidermoid tumor, two rare lesions, has not been reported previously. We also review the literature related to both intramedullary epidermoids and intramedullary abscesses of the spinal cord. Advances in sectional imaging as described should help lead to an early and safe diagnosis of these rare but often debilitating lesions. This case illustrates the importance of a complete neurological assessment of all patients with a congenital dermal sinus because of the potential for intradural extension and the frequent association with other dysraphic abnormalities. Prophylactic surgery is indicated in many cases to prevent dangerous and recurrent infections of the central nervous system.     

Arteriovenous malformation at the cervicomedullary junction: A case report with magnetic resonance imaging

A rare case of arteriovenous malformation at the cervicomedullary junction is reported. A 72-year-old man developed symptoms of total transection of the upper cervical cord without evidence of subarachnoid hemorrhage. The arteriovenous malformation had an intramedullary nidus with an aneurysmal dilatation at the C-1 level. This lesion was diagnosed by magnetic resonance imaging and confirmed at autopsy. The neurological symptoms may have been due to compression of the spinal cord by the intramedullary lesion, followed by degeneration and necrosis. The usefulness of magnetic resonance imaging in the neuroradiological diagnosis is particularly emphasized.