Nichols Noah, Yerneni Ketan, Osorio Joseph A, McDermott Michael, Tan Lee A
Department of Neurological Surgery, UCSF Medical Center, San Francisco, California.
Oper Neurosurg. 2019 Nov 1;17(5):E204. doi: 10.1093/ons/opz019.
Intramedullary spinal epidermoid cysts are rare tumors and only account for 1% of all spinal tumors in adults. Epidermoid cysts can develop from ectodermal tissue that was inappropriately positioned in the primitive neural tube during closure; acquired forms exist for epidermoid cysts as they can emerge in an iatrogenic manner following repeated lumbar punctures. Malignant progression of epidermoid cysts is extremely rare, and symptoms typically depend on tumor location. Surgical resection is the preferred treatment. Gross total resection is ideal; however, partial resections have demonstrated satisfactory long-term outcomes. We present a 54-yr-old man with symptomatic recurrence of thoracic intramedullary epidermoid cyst after two prior resections (25 yr and 11 yr ago, respectively). The patient noted worsening back pain, leg spasticity and weakness. Magnetic resonance imaging (MRI) of the thoracic spine demonstrated interval expansion of the upper thoracic intramedullary epidermoid cyst compared to surveillance MRI from 3 yr prior. Given the progressive nature of symptoms, the patient elected to have surgical resection of the tumor. This operative video highlights the technique and surgical nuances of gross-total resection of a recurrent thoracic intramedullary spinal epidermoid cyst. This patient was noted to have a stable neurological exam at the 6-mo follow-up visit with planned adjuvant radiation treatment. There is no identifying information in this video. Patient consent was obtained for publishing of the material included in the video.
脊髓髓内表皮样囊肿是罕见肿瘤，仅占成人所有脊柱肿瘤的1%。表皮样囊肿可由在神经管闭合期间异位的外胚层组织发展而来；表皮样囊肿也有后天形成的，可因反复腰椎穿刺医源性产生。表皮样囊肿的恶性进展极为罕见，症状通常取决于肿瘤位置。手术切除是首选治疗方法。全切除是理想的；然而，部分切除也显示出令人满意的长期效果。我们报告一名54岁男性，曾分别于25年前和11年前接受过两次手术切除，现出现有症状的胸段脊髓髓内表皮样囊肿复发。患者自述背痛、腿部痉挛和无力加重。胸椎磁共振成像（MRI）显示，与3年前的监测MRI相比，胸段脊髓髓内表皮样囊肿上部出现间隔性扩大。鉴于症状呈进行性发展，患者选择接受肿瘤手术切除。本手术视频重点展示了复发性胸段脊髓髓内表皮样囊肿全切除的技术和手术细节。该患者在术后6个月随访时神经检查稳定，计划接受辅助放疗。本视频中未包含可识别身份的信息。已获得患者同意发布视频中的资料。
