Wang Jinlong, Cao Bo
Department of Neurosurgery, Shengli Oilfield Central Hospital, Dongying, China.
Department of Orthopedics Center, Affiliated Qingyuan Hospital, Qingyuan People's Hospital, The Sixth Clinical Medical School, Guangzhou Medical University, Qingyuan, China.
Case Rep Neurol. 2024 Sep 18;16(1):249-255. doi: 10.1159/000541522. eCollection 2024 Jan-Dec.
Spinal teratomas are rare, accounting for nearly 0.2-0.5% of all spinal tumors and 2% of all teratomas. Teratomas at the conus medullaris location do not inherently lead to epilepsy. However, potential epileptic seizures are caused when teratoma ruptures and the chemical stimulation of teratoma components enter the dural sac.
A 31-year-old Asian male patient suffering from epileptic onset and poor antiepileptic treatment was demonstrated. The spinal imaging examination was performed, and the patient suffered a space-occupying lesion within the conus medullaris related to spinal deformity, spinal embolism, etc. The autoimmune encephalitis spectrum revealed mGluR5 antibody IgG (+) 1:10 response. The patient stabilized after treatment with hormones and human immunoglobulin. Some hair and lipid droplets could be observed in the dural sac intraoperatively, and more hair and lipid-like material were present in the spinal cord. Postoperative pathology established the diagnosis as a conus medullaris teratoma in adults. Epileptic seizures stopped after surgery, and no additional seizures were reported during the 33-month follow-up period.
Conus medullaris teratoma rupture in adults rarely causes epileptic seizures. For spinal deformity patients with unexplained epileptic symptoms, spinal MRI can be helpful in early diagnosis, and more appropriate treatment improves disease prognosis.
脊髓畸胎瘤较为罕见，占所有脊髓肿瘤的近0.2 - 0.5%，占所有畸胎瘤的2%。圆锥部位的畸胎瘤本身不会引发癫痫。然而，当畸胎瘤破裂且其成分的化学刺激进入硬膜囊时，就会引发潜在的癫痫发作。
展示了一名31岁的亚洲男性患者，患有癫痫发作且抗癫痫治疗效果不佳。进行了脊髓成像检查，患者圆锥部位存在与脊柱畸形、脊髓栓塞等相关的占位性病变。自身免疫性脑炎谱显示代谢型谷氨酸受体5（mGluR5）抗体IgG（+）呈1:10反应。患者经激素和人免疫球蛋白治疗后病情稳定。术中在硬膜囊内观察到一些毛发和脂滴，脊髓中存在更多毛发和类脂质物质。术后病理确诊为成人圆锥畸胎瘤。术后癫痫发作停止，在33个月的随访期内未报告再次发作。
成人圆锥畸胎瘤破裂很少引起癫痫发作。对于有不明原因癫痫症状的脊柱畸形患者，脊髓磁共振成像（MRI）有助于早期诊断，更恰当的治疗可改善疾病预后。
