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Intraspinal epidermoid and dermoid cysts—tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome

  • Original Article - Spine - Other
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Abstract

Background

Intraspinal epidermoid/dermoid cysts are very rare, benign tumors arising from pathological displacement of epidermal cells into the spinal canal. Literature data about the long-term outcome after microsurgical resection with multimodal intraoperative neurophysiological monitoring (IONM) are lacking. We analyzed one of the largest case series with special regard to intraoperative characteristics and long-term outcome after IONM-aided surgery.

Method

All 12 patients (m:f = 1.4:1) who underwent microsurgical tumor resection with multimodal IONM for intraspinal epidermoid/dermoid tumors between 1998 and 2019 in our university hospital were included. We retrospectively investigated the patients’ characteristics, imaging/surgical parameters, and postoperative long-term outcomes.

Results

Symptomatic tumor manifestation was seen during adulthood in 4 patients (median age 33.0 years) and during childhood in 8 patients (median age 4.3 years). Spinal dysraphism was the most often comorbidity (75%). The most frequent symptoms at diagnosis were spastic pareses (75%), ataxia (58%), and vegetative disorders (42%). Tumors were most often lumbosacral (L1–L5 42%, L5–S3 50%) and intradural-extramedullary (92%). For microsurgical resection, IONM with EMG, SSEPs, and TcMEPs of the limbs and pudendal nerve/anal sphincter was always applied and feasible; intraoperative corrective actions were initiated in three cases due to transient IONM deterioration. None of the patients showed a postoperative deterioration of the neurological status with a gross total resection rate of 92%. Pain situation, McCormick grade, and mJOA Score were improved at long-term follow-up (median 4.8 years).

Conclusions

IONM-aided resection of intraspinal epidermoid/dermoid tumors is feasible both in adult and pediatric cases and enables a satisfying clinical and surgical outcome.

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Abbreviations

ca.:

Circa

CNS:

Central nervous system

DWI:

Diffusion-weighted imaging

EMG:

Electromyography

IONM:

Intraoperative neurophysiological monitoring

mJOA:

Modified Japanese Orthopedic Association score

MMC:

Myelomeningocele

MRI:

Magnetic resonance imaging

resp.:

Respectively

SSEPs:

Somatosensory evoked potentials

TcMEPs:

Transcranial motor evoked potentials

WHO:

World Health Organization

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Acknowledgments

We are grateful to all patients participating in our study

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Authors and Affiliations

  1. Neurosurgical Clinic, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany

    Sebastian Siller, Andrea Szelenyi, Joerg-Christian Tonn, Stefan Zausinger & Christian Schichor

  2. Center for Neuropathology and Prion Research, Clinic of the University of Munich (Ludwig Maximilians University), Campus Grosshadern, Marchioninistrasse 15, D-81377, Munich, Germany

    Rupert Egensperger

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  1. Sebastian Siller
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Correspondence to Sebastian Siller.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the local Institutional Review Board of the Ludwig-Maximilians-University Munich and agrees with all standards regarding the use of informed consent according to the guidelines of the local Institutional Review Board of the Ludwig-Maximilians-University Munich (Project No. 19-569).

Informed consent

Informed consent was obtained from participants included in the study according to the guidelines of the local Institutional Review Board of the Ludwig-Maximilians-University Munich (Project No. 19-569).

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Siller, S., Egensperger, R., Szelenyi, A. et al. Intraspinal epidermoid and dermoid cysts—tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome. Acta Neurochir 162, 2895–2903 (2020). https://doi.org/10.1007/s00701-020-04446-y

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