Iatrogenic intraspinal epidermoid tumor: two cases and a review of the literature
STUDY DESIGN: Two cases of patients whom intraspinal epidermoid tumors presented and were successfully removed 6 years after neonatal lumbar puncture are reported.
OBJECTIVE: To describe the presentation of this type of spinal tumor and strategies for diagnosis and treatment.
SUMMARY OF BACKGROUND DATA: Cells iatrogenically implanted into the spinal canal during lumbar puncture can slowly grow until symptomatic. Diagnosis can be difficult and is often delayed. MRI appears to offer some advantages in diagnosis provided that gadolinium is used. Treatment is by surgical excision.
METHODS: The first patient, a 6-year-old boy, presented with severe episodic hip pain of unknown etiology. MRI of the lumbar spine revealed a 1-cm epidermoid at L1-L2. The second child, a 6-year-old girl, presented with low back pain and dragging of the feet. MRI revealed a mass at L3.
RESULTS: In both cases, complete excision via lumbar laminectomy was performed. Both patients were asymptomatic at the 1-year follow-up with resolution of preoperative weakness.
CONCLUSIONS: This study highlights an uncommon but not rare tumor that may present to the spine specialist in a variety of ways. The diagnosis is often delayed. The advent of MRI has improved the ease and accuracy of diagnosis. Complete excision is usually possible and is curative.