Rare intradural spinal neoplasm Case Report Dr Nidal

Rare intradural spinal neoplasm Case Report Dr. Nidal Abuhadrous Arab Board of Neurosurgery Member of the Royal College of Surgeons in Ireland Member of the American Association of Neurological Surgeons Member of the Congress of Neurological Surgeons, USA nidal_hadrous@yahoo. com 1

Case presentation 2

Presentation • 16 years old female • Presented to A&E – EGH on 9/9/14 • Seen by orthopedic resident • Presentation: Severe low back pain, severe bilateral lower limb pain and numbness and walking difficulty for 12 days 3

History & Examination • History: No significant past medical history • Examination: – Looks in pain – Needs assistance to ambulate. Abnormal gait (scoliotic & bended back) – Hypesthesia Rt lower limb – Motor power & sphincters: grossly intact 4

X-rays • X-rays LS spine was interpreted as: – Mild scoliosis – Hyperlordosis – Spina bifida Ø She was admitted to orthopedic department for further evaluation 5

Spina bifida occulta 6

Preop MRI 7

Preop MRI + Contrast 8

STIR 9

Neurosurgery consultation • Neurosurgery department was consulted • Condition explained to the patient & parents, including the need for surgical excision ASAP • Informed consent obtained & the patient was shifted to neurosurgical ward 10

Surgery • Total excision of the tumor was performed on 14. 09. 2014 by neurosurgery team. • No intraoperative complications 11

Intraoperative findings • Large lesion severely compressing & displacing the cord to the Lt. • It was unsafe to remove it in one piece. • Tumor was opened for debulking. It was cystic with small whitish debris found inside (Hint!) • Wall was adherent to the dura on the Rt side, but we were able to achieve total excision. 12

Postoperative course • Smooth • 1 st postop day photo 13

Histopathology • Cystic lesion: – The wall is composed of keratinizing stratified squamous epithelium with a prominent granular layer. – The lumen contains keratin flakes. • Conclusion: Epidermoid cyst 14

Preop 2 d postop 2 yrs postop 15

Preop 2 d postop 2 yrs postop 16

March 2017 17

Spinal Epidermid Cyst • Account for 0. 5 -1% of all intraspinal tumors. • Few case reports in the literature. • Usually intradural extramedullary. • May be congenital or acquired. • Complete surgical excision is the treatment of choice, and when possible it is curative. • Chemical meningitis is not uncommon! 18

Conclusion Why this case? Ø Rare Ø Thoracic level Ø Total excision was achieved Ø Spinal cord preserved Ø Chemical meningitis prevented 19

Thanks 20