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Case Reports
. 2014 Jan;9(1):21-6.
doi: 10.4103/1817-1745.131475.

Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: Observations and outcomes

Sudhakar Vadivelu  1 , Sohum K Desai  1 , Anna Illner  1 , Thomas G Luerssen  1 , Andrew Jea  1
Affiliations
Case Reports

Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: Observations and outcomes

Sudhakar Vadivelu et al. J Pediatr Neurosci. 2014 Jan.

Abstract

We report two unusual cases of a 17-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an intradural dermoid cyst and holocord edema or syrinx, presenting with paraparesis and sphincter dysfunction secondary to an intramedullary abscess and a 26-month-old boy with a previously undiagnosed lumbar dermal sinus tract terminating in an infected dermoid cyst and intramedullary abscess, presenting with recurrent episodes of meningitis and hydrocephalus. Pre-operative magnetic resonance imaging (MRI) studies in these patients were initially confused for an intramedullary spinal cord tumor; however, the presence of an associated dermal sinus tract made this diagnosis of neoplasm less likely. Total excision of the dermal sinus tract, debulking of the dermoid cyst and drainage of the intramedullary abscess through an L1-L5 osteoplastic laminoplasty and midline myelotomy, followed by long-term antibiotic therapy resulted in a good functional recovery. Post-operative MRI of the spine showed removal of the dermoid cyst, decreased inflammatory granulation tissue and resolution of the holocord edema or syrinx. We also performed a literature review to determine the cumulative experience of management of intramedullary abscess in this rare clinical setting.

Keywords: Dermal sinus tract; dermoid cyst; intramedullary abscess; magnetic resonance imaging.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Pre-operative mid-sagittal short-tau inversion recovery and (b) contrast-enhanced T1-weighted lumbar spine MRI demonstrate a heterogenous enhancing intradural mass from L1 to S1 with some septated fluid/cystic elements. The cauda equina and conus medullaris cannot be identified. There is adjacent cord edema. In retrospect, a dorsal dermal sinus can be seen (arrow, b)
Figure 2
Figure 2
Pre-operative cervical T2-weighted mid-sagittal magnetic resonance imaging shows holocord edema or syrinx up to the level of the medulla
Figure 3
Figure 3
(a) Pre-operative mid-sagittal contrast-enhanced T1-weighted lumbar spine magnetic resonance imaging demonstrates a heterogenous thick rim-enhancing intradural mass from L1 to S1 with multi-septated fluid/cystic components. The cauda equina and conus medullaris cannot be identified. (b) A dorsal dermal sinus tract (arrow) can be seen on sagittal T2-weighted images
Figure 4
Figure 4
Pre-operative thoracic T2-weighted mid-sagittal magnetic resonance imaging shows T2-hyperintensity extending from T4 along the remaining caudal length of the spinal cord
Figure 5
Figure 5
Post-operative T2-weighted mid-sagittal magnetic resonance imaging of the (a) thoracic and (b) lumbar spine at 6 months after surgery shows partial decompression of the dermoid cyst with residual dermoid cyst centered at the L4-5 level. There is interval resolution of the syrinx and improved edema of the spinal cord
See this image and copyright information in PMC

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