Conus medullaris epidermoid cyst: a rare cause of chronic Conus medullaris Syndrome: case report and systematic review.

BACKGROUND

Spinal epidermoid cysts are rare, accounting for less than 1% of all intraspinal tumors. Their occurrence in the conus medullaris is exceedingly uncommon and can mimic other causes of spinal cord compression.

CASE PRESENTATION: We report the case of a 43-year-old man with progressive bilateral lower limb weakness and urinary retention over the course of one year. MRI revealed a non-enhancing cystic lesion in the conus medullaris. The patient underwent laminectomy with subtotal excision of the cyst. Histopathology confirmed an epidermoid cyst. Postoperatively, the patient experienced significant improvement in motor function and partial recovery of urinary symptoms.

METHODS

A structured systematic review was conducted according to PRISMA guidelines using PubMed and Scopus databases. Search terms included "epidermoid cyst" "spinal cord compression," and "conus medullaris." After screening and applying inclusion criteria, 20 studies comprising 31 cases were included.

RESULTS

Patients ranged from 2 to 69 years, with a slight female predominance. Common presenting symptoms included lower back pain, paraparesis, and urinary dysfunction. Most patients underwent laminectomy or laminotomy with cyst resection. Outcomes were generally favorable, particularly with early surgical intervention. However, residual deficits were noted in cases with delayed diagnosis or partial resection.

CONCLUSION

This report presents a rare case of conus medullaris epidermoid cyst and provides the first structured systematic review of the literature. Early recognition, accurate imaging, and careful surgical planning are critical for optimizing outcomes.