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

The introduction of computed tomography (CT) myelography for spinal diseases has allowed the diagnosis of several intradural and extradural etiologies. With the advent of water-soluble, nonionic contrast agents, the safety and availability of this technique have expanded. Although magnetic resonance imaging (MRI) has faded the indications for CT myelography, some specific conditions and settings still benefit from the functional flow of contrast in the subarachnoid space and/or the patient's particular limitations in performing MRI (especially in the presence of intense metallic artifacts). We present the case of a 23-year-old male patient who underwent long-term follow-up for an intramedullary epidermoid cyst. At the time of diagnosis, the patient complained of right lower limb tremor and pain, which progressed to leg weakness, with no congenital abnormality. His first surgery resulted in a mass resection without spinal fixation. Three years later, thoracic canal stenosis and kyphosis were diagnosed, leading to a second surgery, consisting of laminectomy and cervicothoracic fixation. At 8 years of age, worsening weakness and sphincter issues prompted further evaluations. CT myelography revealed upper thoracic cord enlargement. An intramedullary epidermoid cyst was diagnosed, and the patient underwent a new gross total resection. CT myelography is not obsolete. Patients requiring spine imaging for oncologic control and/or new or worsening neurological symptoms may benefit from CT myelography when standard spine MRI cannot be performed. Epidermoid cysts require long-term postoperative follow-up, as recurrence may occur years after surgical resection owing to their indolent, benign behavior.