Ruptured spinal dermoid with central canal and intraventricular extension

Sameer Vyas, Suresh Giragani, Paramjeet Singh, Niranjan Khandelwal 
 Departments of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
Sameer Vyas
Senior Research Associate, Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh
India

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A 35-year-old male presented with history of pain and weakness of both the lower limbs 15 years back. Magnetic resonance imaging (MRI) done at that time showed dermoid in the lumbosacral region. Dubulking surgery was performed 7 years back. For the last 4 years, he developed numbness and weakness of all the four limbs with bladder and bowel incontinence. On examination, he had wasting and weakness of leg muscles and sensory loss in the radicular distribution in the lower limbs with absent deep tendon reflexes in the lower limbs. Bulbocavernous reflex was absent. The MRI of the whole spine revealed presence of heterogeneous dermoid at the conus medullaris with central canal and cranial extension of the fat droplets [Figure 1] and [Figure 2].{Figure 1}{Figure 2}

Dermoids are rare congenital tumors comprising 1.1% of the intraspinal tumors, with lumbosacral region and cauda equine being the common sites. [1],[2] Although they are benign, they can grow in size due to accumulation of secretions and may rupture. They may rupture spontaneously or following surgery or trauma. The resultant rupture can be into the subarachnoid space, central canal and ventricles. [2],[3] These can be asymptomatic or cause symptoms secondary to obstructive hydrocephalus or chemical meningitis. With the frequent use of MRI, spontaneous dermoid rupture is now diagnosed with confidence even in asymptomatic patients. [3] MRI is the most important radiologic modality to diagnose the presence and distribution of ruptured tumor content into the subarachnoidal space or into the central spinal canal, as in this patient, and also to detect complications such as hydrocephalus or meningitis after rupture and for follow-up after surgery. [1],[2],[3]

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