Upper Lumbar Mature Cystic Teratoma: A Case Report

Intradural extramedullary spinal teratoma (IEST) is a rare condition in adults, with a male predominance. It is commonly associated with spinal dysraphism, lumbar puncture, and previous spinal surgery. This case is a 37-year-old male diagnosed with a mature cystic IEST without dysraphism or previous surgical interventions.

The patient's symptoms included a lumbar backache that progressed to the toes, as well as the anterior region of both thighs. Subsequently, he could not walk for >3 minutes and experienced saddle paresthesias, heaviness, and numbness in both lower limbs. The teratoma was diagnosed by magnetic resonance imaging (MRI), which showed a mixed signal intensity mass with a fatty component in the conus medullaris at the L1-L2 level. The treatment strategy included total surgical excision of the teratoma, followed by histopathological examination, at which the mass was diagnosed as a mature cystic teratoma. On postoperative follow-up, the patient reported urinary and fecal incontinence. Neurologic examination of both the lower limbs revealed hyperreflexia of the left knee and atrophy of the left calf muscles, but no residual mass at the site of surgery.

MRI is a standard tool for diagnosing IEST, but the diagnosis is confirmed by histopathological examination. Total surgical excision is the treatment of choice, but when adhesions to the neural tissue are present, subtotal excision should be attempted. The patient should be followed up with serial clinical and radiologic examinations to ensure the absence of residual mass at the site of surgery.