Intramedullary Epidermoid Cyst Recurrence Diagnosed With Computed Tomography Myelography: A Case Report

Area of Science:

• Neurosurgery
• Radiology
• Spinal Imaging

Background:

• Computed tomography (CT) myelography, using water-soluble, nonionic contrast agents, aids in diagnosing spinal diseases.
• While magnetic resonance imaging (MRI) is prevalent, CT myelography offers benefits in specific scenarios, including patient limitations for MRI and the need to visualize contrast flow.

Purpose of the Study:

• To present a case study of intramedullary epidermoid cyst management requiring long-term follow-up.
• To underscore the continued relevance of CT myelography in specific clinical situations, particularly when MRI is contraindicated or suboptimal.

Main Methods:

• A case report of a 23-year-old male with an intramedullary epidermoid cyst is detailed.
• Diagnostic imaging included CT myelography to assess thoracic cord enlargement and guide surgical intervention.
• The patient underwent multiple surgical resections and spinal fixation over a prolonged follow-up period.

Main Results:

• CT myelography successfully identified upper thoracic cord enlargement, leading to the diagnosis of an intramedullary epidermoid cyst.
• The patient experienced progressive neurological symptoms, including tremor, pain, weakness, and sphincter issues, necessitating surgical interventions.
• Long-term follow-up was crucial due to the potential for recurrence of epidermoid cysts.

Conclusions:

• CT myelography is a valuable diagnostic tool for spinal imaging, especially when MRI is not feasible or yields suboptimal results.
• Intramedullary epidermoid cysts require vigilant long-term postoperative monitoring for recurrence, even years after initial resection.
• This case reinforces the utility of CT myelography in managing complex spinal pathologies and highlights the importance of comprehensive patient follow-up.