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Intraspinal Epidermoid Tumor of the Cauda Equina Region: Seven Cases and a Review of the Literature

Morita, Masahiro MD*; Miyauchi, Akira MD, PhD*; Okuda, Shinya MD, PhD*; Oda, Takenori MD, PhD*; Aono, Hiroyuki MD, PhD; Iwasaki, Motoki MD, PhD

doi: 10.1097/BSD.0b013e31821e2464
Original Articles

Study Design Retrospective case series.

Objective To investigate the clinical features and surgical outcomes of patients with intraspinal epidermoid tumor of the cauda equina region.

Summary of Background Data Intraspinal epidermoid tumor of the cauda equina region is very rare, and the majority of the existing literature of this condition comprises case reports with a few case series.

Methods The clinical features and surgical outcomes of 7 patients (2 males, 5 females; age range, 4-66 y) with intraspinal epidermoid tumor of the cauda equina region were retrospectively studied, and a literature review was performed. All patients complained of neurologic symptoms and underwent microscope-assisted surgery. The mean duration of postoperative follow-up was 126 months (range, 52-209 mo).

Results Antecedent lumbar puncture had been performed on 3 patients, and 4 cases thought to be of congenital origin without a past history of lumbar puncture had no associated anomalies, such as spina bifida or dermal sinus. Postoperatively, complications occurred in 3 patients concerning cauda equina symptom. Two patients (29%) had tumor recurrence, diagnosed 1 and 13 years after surgery, respectively. Immediately after additional surgery for tumor recurrence, both patients had severe paresis of the hemilateral foot.

Conclusions Complete removal without tear of the tumor was difficult in our case series, because the capsule of the tumor was thin and often adhered to the cauda equina nerve roots or dura mater. However, total resection of the capsule is important, because patients with epidermoid tumor are at risk for recurrence. On the other hand, aggressive resection of the capsule adhering to the neural elements can cause a high rate of neurological complications postoperatively, especially after surgery for tumor recurrence.

*Department of Orthopaedic Surgery, Osaka Rosai Hosipital

Department of Orthopaedic Surgery, Osaka National Hospital

Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan

The authors declare no conflict of interest.

Reprints: Masahiro Morita, MD, Department of Orthopaedic Surgery, Izumi Municipal Hospital, 4-10-10 Fuchu Izumi City, Osaka, 594-0071, Japan (e-mail:

Received February 9, 2011

Accepted April 5, 2011

© 2012 Lippincott Williams & Wilkins, Inc.