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Long segment spinal intramedullary dermoid cyst: A case report.

Hina Anwer1, Faiq Sheikh2, Muhammad Anwar Chaudary2

  • 1Punjab Institute of Neurosciences (PINS), Lahore General Hospital, Punjab, Pakistan.

International Journal of Surgery Case Reports
|October 4, 2021
PubMed
Summary

A rare, long-segment spinal intramedullary dermoid cyst in an adult without trauma is presented. Fat suppression MRI is crucial for diagnosing intramedullary hyperintensity, aiding early management and reducing patient morbidity.

Keywords:
Good resultHyperintense spinal lesionSpinal intramedullary dermoidSurgery

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Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Spinal intramedullary dermoid cysts are rare tumors (<1% of intraspinal tumors), often congenital, typically presenting in young adults.
  • These cysts can be asymptomatic or present acutely upon rupture, potentially associated with spinal dysraphism.
  • Long segment involvement in adults without a history of trauma is highly unusual.

Purpose of the Study:

  • To report a unique case of a large spinal intramedullary dermoid cyst in an adult.
  • To highlight the diagnostic utility of fat suppression MRI in intramedullary lesions.
  • To emphasize the importance of early diagnosis and management for reducing patient morbidity.

Main Methods:

  • A case report of a 30-year-old male with sudden urinary retention and rapidly progressive quadriparesis.
  • Spinal MRI revealed an intramedullary tumor spanning from the medulla to D5 vertebra.
  • Subtotal tumor excision followed by histopathological confirmation of a dermoid cyst.

Main Results:

  • The patient presented with acute neurological deficits including urinary retention and quadriparesis.
  • MRI demonstrated extensive intramedullary hyperintensity in T1 and T2 sequences, suggestive of adipose tissue.
  • Histopathology confirmed the lesion as an intramedullary spinal dermoid cyst.

Conclusions:

  • This case underscores the rarity of long segment intramedullary dermoid cysts in adults without trauma.
  • Fat suppression MRI is essential for differentiating adipose lesions from hematomyelia in cases of T1/T2 intramedullary hyperintensity.
  • Prompt diagnosis and surgical intervention are vital for improving outcomes and minimizing neurological deficits.