J Korean Soc Spine Surg.  2016 Jun;23(2):121-126. 10.4184/jkss.2016.23.2.121.

Extensive Intradural Epidermoid Cysts with Cauda Equina Syndrome in the Lumbosacral Spine: Case Report

• Ahn TK
• Shin DE
• Kwon YW
• Lee SJ

• KMID: 2328006
• DOI: http://doi.org/10.4184/jkss.2016.23.2.121

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To report a rare case of extensive epidermoid cysts in the lumbosacral spine. SUMMARY OF LITERATURE REVIEW: The intradural epidermoid cyst with extensive involvement is rare, and previous reports have reported only extensive intramedullary epidermoid cysts.
MATERIALS AND METHODS
A 75-year-old male presented with progressive motor weakness of both extremities beginning 3 days prior. MRI showed extensive intradural extramedullary epidermoid cysts in the lumbosacral region. We performed total laminectomy from the L1 to the L5 level, and the cystic mass was removed.
RESULTS
We confirmed the epidermoid cyst on histopathologic examination.
CONCLUSIONS
Extensive extramedullary epidermoid cysts are difficult to remove completely. Attempting complete removal may result in neurological deficit. Therefore, when surgical intervention is planned, the poor postoperative prognosis should be taken into consideration.

Keyword

Cauda equina syndrome; Intradural-extramedullary; Epidermoid cyst

MeSH Terms

Aged
Cauda Equina*
Epidermal Cyst*
Extremities
Humans
Laminectomy
Lumbosacral Region
Magnetic Resonance Imaging
Male
Polyradiculopathy*
Prognosis
Spine*

Figure

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  Fig. 1. Preoperative T1-weighted MRI sagittal (A) and T2-weighted MRI sagittal (B) images show an extramedullary elongated mass extending from the L1 to L5 level without widening of the spinal canal.

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  Fig. 2. Enhanced T1-weighted sagittal MRI reveals a thin rim enhancement around the mass.

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  Fig. 3. (A-B) Intraoperative images show intradural epidermoid cyst.

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  Fig. 4. Gross photo (A) and histopathological image (B, H&E stain, 1×) show a Calcified bone.

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  Fig. 5. A histopathological image (A, H&E stain, 1×) and another histopathological image (B, H&E stain, 4×) show an epidermoid cyst.

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