Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
World Neurosurg. 2019 Jul;127:113-116. doi: 10.1016/j.wneu.2019.03.262. Epub 2019 Apr 2.
Spinal epidermoid cysts are very rare tumors, especially in the thoracic spine; they represent 0.8% of all spinal epidermoids. In adult cases, they are often associated with surgical procedures such as lumbar puncture. We report a rare case of spinal epidermoid cyst in the thoracic spine of an elderly patient who had never undergone lumber puncture, thoracic spinal surgery, or trauma.
A 78-year old woman presented with a 1-month history of rapidly progressive impairment of sensation in both the lower limbs, with gait disturbance. She had no history of spinal surgery, trauma, or lumbar puncture. Her past medical history was unremarkable. Magnetic resonance imaging of the whole spine revealed an intraspinalextramedullary tumor at the Th 1-2 level. Diffusion-weighted imaging revealed significant homogeneous high intensity. We performed complete resection without damaging the spinal cord or nerve roots. The final histological examination indicated epidermoid cyst without malignancy. Her gait disturbance was completely resolved at 4-month follow-up.
Epidermoid cysts must be considered among spinal tumors in elderly patients. Early detection by diffusion-weighted imaging and complete resection may lead to good neurological outcome.
脊髓表皮样囊肿是非常罕见的肿瘤，特别是在胸椎；它们占所有脊髓表皮样瘤的 0.8%。在成人病例中，它们常与腰椎穿刺等外科手术有关。我们报告一例老年患者胸椎表皮样囊肿的罕见病例，该患者从未接受过腰椎穿刺、胸椎脊柱手术或外伤。
一名 78 岁女性，因双下肢感觉迅速进行性恶化伴步态障碍，出现症状 1 个月。她没有脊柱手术、外伤或腰椎穿刺的病史。她的既往病史无特殊。全脊柱磁共振成像显示胸 1-2 水平椎管内髓外肿瘤。弥散加权成像显示明显均匀高信号。我们在不损伤脊髓或神经根的情况下进行了完全切除。最终的组织学检查表明为表皮样囊肿，无恶性肿瘤。她的步态障碍在 4 个月的随访时完全缓解。
在老年患者的脊髓肿瘤中必须考虑表皮样囊肿。通过弥散加权成像早期发现并进行完全切除可能会获得良好的神经学结局。
