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Intramedullary teratomas: Two case reports and a review of the literature
1University La Sapienza Rome, Chief Department of Neurosurgery of the Army Medical Centre of Rome, Italy. ricccaru@tin.it
Objective:
Intramedullary teratomas are extremely rare tumours. A review of the literature found only reports of 59 cases, three of which were treated by us. The most common localisation for these tumours is in the medullary conus. According to our experience as well as more recent reports, MRI images allow a preoperative diagnosis to be made.
Clinical Presentation:
We treated two cases of intramedullary teratoma of the conus: that of a 41-year-old woman and that of a 40-year-old man. Both suffered from motor and sensory disorders, and the woman also suffered from urinary disorders. CT and MRI enabled us to diagnose an intramedullary tumour and to suspect a dysembryogenic origin.
Intervention:
Both patients were treated surgically; the surgical removal of the tumour was extensive but not total because of the tenacious adhesions of the tumour to the adjacent parenchyma.
Conclusion:
Surgery is the therapy of choice in cases of intramedullary teratomas; the removal, though incomplete, leads to a definite improvement of symptoms. In our two cases the follow-up has been 7 years and 6 years, respectively. No tumour regrowth occurred during this period.
Insights
Intramedullary teratomas are rare spinal cord tumors. Surgical removal, even if incomplete, significantly improves patient symptoms and shows no regrowth in long-term follow-up.
Area of Science:
- Neurology
- Neurosurgery
- Oncology
Background:
- Intramedullary teratomas are exceptionally rare spinal cord neoplasms, with limited documented cases.
- The medullary conus is the most frequent site for these dysembryogenic tumors.
Observation:
- Magnetic Resonance Imaging (MRI) facilitates preoperative diagnosis of intramedullary teratomas.
- Two cases of conus medullaris intramedullary teratoma presented with motor, sensory, and urinary deficits.
Findings:
- Surgical intervention is the primary treatment for intramedullary teratomas.
- Extensive but incomplete tumor resection was performed due to adherence to spinal cord parenchyma.
- Post-operative follow-up exceeding six years showed no evidence of tumor recurrence in either patient.
Implications:
- Incomplete surgical resection of intramedullary teratomas can lead to significant clinical improvement.
- Long-term monitoring is crucial to ensure no tumor regrowth after surgical management.
- Early diagnosis through advanced imaging like MRI is vital for effective treatment planning.
