Journal de colonne vertébrale et de neurochirurgie

Spinal Epidermoid Tumor – A Rare and Silent Occurrence

Luis Cardoso, Ricardo Nogueira, Lino Fonseca and Anabela Nabais

Objective: Epidermoid tumors are slow-growing benign lesions lined by squamous epithelium. Are rare, commonly intracranial and spinal intradural epidermoid tumors are extremely rare. The authors propose to describe a clinical case of a patient operated. Methods: We report a 75-year-old male referred to neurosurgical consultation by spondylolisthesis at L4-L5 with stenotic spinal canal and a left L4-L5 foraminal stenosis, revealed by lumbosacral CT scan. Neurologic exam revealed a claudicant gait, spastic paraparesis with muscular strenght of 3-/5 at left and 4+/5 at right. Deep tendon reflexes were increased at left with presence of patelar and ankle clonus, but normally at right. Below left D5 dermatome, he had sensory parestesia. MRI showed an intradural lesion, apparently exclusively extra-medullary at D6 level. This lesion determines a significant spinal cord compression and had identical signal to the CSF in all MRI ponderations. It was performed a D5 laminectomy and median linear durotomy with identification of an intradural tumor (pearl-white color), adjacent to the arachnoid, dissectable from spine cord. Gross total resection was achieved. Results: Postoperatively the patient remained clinically stable and without new deficits. At the 4th month of follow-up the patient progressively recovered and was presenting with muscle strength grade 4/5. Histopathology showed a sample of keratin lamellae, foci of gross calcification, compatible with diagnosis of epidermoid tumor. Conclusion: This case demonstrates that even being a rare pathology we must have it present in our clinical reasoning so we can diagnose it properly. It also reveals a case of associated pathology of the spine, which could delay the diagnosis, increasing the risk of worsening of permanent neurological deficit. The goal is always the complete surgical resection and so, because of is benign nature and low rate of recurrence the patients may improve clinically and can be considered cured.