A Rare Case of Intradural Spinal Cord Dermoid Cyst
A 57-year-old man known to have hypertension, presented with three days history of urinary incontinence, back pain with increasing intensity, left thigh atrophy and left lower limb paralysis over the last 4 weeks. There is a history of lumbar surgery for back pain, urinary incontinence and weakness 36 years prior to his presentation.

Imaging at that time revealed a cyst in the spinal cord which was excised. After the surgery his symptoms resolved completely until now. Lumbar x-ray was done first and showed scalloping of the lumbar vertebrae. MRI was done next and it demonstrated a hyperintense intradural lesion on T2 weighted images that extended from L2 to S1 (Figure 1).

Surgery was performed. A previous laminectomy from L2 till L3 was discovered intraoperatively. The laminectomy was extended to L5. The midline myelotomy performed showed an avascular tumor with a thick wall inside the dura just distal to conus medullaris and pressing the spinal nerves to the periphery (Figure 2). Using the microscope, the tumor wall was incised, and a white semi fluid material was found (Figure 3). Extensive excision of the white material was removed with nerve preservation and partial excision of the tumor wall.

Two weeks postoperatively, the pathology study revealed that the tumor was a dermoid cyst. One month postoperatively, the patient had moderate improvement in his bladder function with marked gain in power of his lower limbs. Two months later the patient was examined at the clinic and showed important improvement in his motor activity with considerable gain in muscle mass. He also reported partial recuperation in his urinary continence along with mild intermittent back pain relieved with pain killers.

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