Dermoid cysts of the conus medullaris: Clinical review, case series and management strategies.

BACKGROUND

The management of dermoid cysts can be tedious as they have a tendency to recur, and respond poorly to chemotherapy and radiation. Management is especially difficult for tumors involving highly eloquent areas such as the conus medullaris.

OBJECTIVE

We aim to provide a summary of the pathology, clinical presentation, and operative management strategies of dermoid cysts involving the conus medullaris.

METHODS

Two clinical cases of dermoid cysts of the conus are presented, as well as a commented surgical video.

RESULTS

A 33 year-old man with a history of cystic conus medullaris tumor presented with progressive low back pain and loss of bowel and bladder function. His magnetic resonance imaging (MRI) scan showed recurrence of his tumor with tethering of the spinal cord. He was taken for a midline myelotomy that drained yellowish keratinous fluid and decompressed the cyst. No aggressive attempt at complete resection of the cyst wall was undertaken. He made a complete recovery after surgery. A 25 year-old woman with a history of dermoid cyst of the conus that was previously treated surgically, presented with lower extremity weakness and debilitating pain. Her MRI showed significant recurrence of the cystic lesion. She was taken for a midline myelotomy and improved after surgery with complete resolution of her symptoms.

CONCLUSION

Dermoid cysts of the conus medullaris are challenging to treat. Surgical control and restraint are key, especially when patients are young and could potentially fully recover and remain in remission for a period of years.