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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2018; 37(02): 140-144
DOI: 10.1055/s-0038-1639605
Case Report | Relato de Caso
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Intramedullary Dermoid Cyst of the Cervical Spinal Cord – C5–C7 Level

Cisto dermoide intermedular da medula espinhal cervical – nível C5–C7
Palanisamy Seerangan
1   Institute of Neurosurgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Aravinth Kumar Ashok
1   Institute of Neurosurgery, Madras Medical College, Chennai, Tamil Nadu, India
,
Jolarpettai Venugopal Mahendran
1   Institute of Neurosurgery, Madras Medical College, Chennai, Tamil Nadu, India
› Author Affiliations
Further Information

Publication History

23 November 2017

05 January 2018

Publication Date:
27 March 2018 (online)

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Abstract

Introduction Inclusion cysts of the spinal cord are rarely intramedullary. Such cysts are commonly located in the lumbar and thoracic regions and are usually associated with congenital spinal dysraphism and dermal sinus. Intramedullary dermoid cysts in the cervical region without spinal dysraphism are extremely rare. To our knowledge, only seven such cases are reported in the literature to date.

Materials and Methods An 18-year-old female patient presented with weakness in all four limbs, more distal than proximal muscle weakness, that had been progressing for 3 years. The magnetic resonance imaging (MRI) showed an intramedullary lesion from C5– C7 with peripheral ring enhancement. “Whorls” were observed within the lesion on T2 weighted image, with associated excavation of vertebral bodies C5– C7. Operative procedure and findings: partial laminectomy of C5– D1was performed. The dura was opened. A small myelotomy was made in the root entry zone. About 1.5 ml of yellowish colored fluid was drained. White shiny debris with hair, whitish pultaceous content and teeth were removed. Complete excision of cyst and its wall was performed.

Results The histopathological examination revealed that the cyst wall was lined by stratified squamous epithelium with underlying dermis showing hair follicles, sebaceous glands, adipose tissue and cyst filled with keratin debris suggestive of dermoid cyst.

Conclusion The intramedullary location of the dermoid cyst in the cervical cord and the absence of any congenital spinal dysraphism make this case a very unique and rare entity and warrants its inclusion in the reported cases of rare intramedullary space occupying lesions.

Resumo

Introdução Cistos de inclusão da medula espinhal raramente são intramedulares. Tais cistos são comumente localizados nas regiões lombares e torácicas e geralmente estão associados com disrafismo espinhal congênito e sinus dérmico. Cistos dermoides intramedulares na região cervical sem a presença de disrafismo espinhal são extremamente raros. Apenas sete casos foram relatados na literatura até a data do presente estudo.

Materiais e Métodos Uma paciente de 18 anos de idade apresentou fraqueza nos quatro membros, mais distal que proximal, com três anos progressivos de duração. A ressonância magnética apresentou uma lesão intramedular de C5 a C7 com realce do anel periférico. Espirais foram observadas dentro da lesão na imagem ponderada em T2 , com escavação dos corpos vertebrais C5–C7. Procedimentos operatórios e achados: realização de laminectomia parcial de C5 a D1. A dura cervical foi aberta. Uma pequena mielotomia foi feita na zona de entrada da raiz. Cerca de 1,5 ml de fluído amarelado foi extraído. Detritos brancos brilhantes com cabelo, polpa esbranquiçada e dentes foram removidos. Foi realizada a excisão completa do cisto com parede de cisto.

Resultados O exame histopatológico revelou que a parede do cisto estava alinhada por epitélio escamoso estratificado com derme subjacente apresentando folículos capilares, glândulas sebáceas, tecido adiposo e cisto cheio de detritos de creatinina, sugerindo cisto dermoide.

Conclusão A posição intramedular do cisto dermoide no cordão cervical e a ausência de disrafismo espinhal congênito faz deste um caso único, uma entidade rara, e assegura sua inclusão junto aos casos relatados de lesões raras ocupando espaço intramedulares.

Keywords

intramedullary dermoid cyst - cervical spinal cord - rare presentation - absence of spinal dysraphism

Palavras-chave

cisto dermoide intramedular - cordão cervical medular - apresentação rara - ausência de disrafia espinhal
 

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