Spinal Dermoid and Epidermoid Cysts: Symptoms, Diagnosis, Treatment

Overview

Dermoid and epidermoid cysts are often referred to as dermoid and epidermoid tumors. As a slow-growing benign cyst, they are typically seen in infants and children. As for spinal dermoid and epidermoid cysts, the cysts are growths in the spine.

Although dermoid cysts are the most common orbital tumors, or periorbital tumors, it is fairly rare for a dermoid tumor to grow in the spinal cord.

Typically, dermoid cysts arise due to implantation of epithelial tissue into another structure. As for epidermoid cysts, they share a similar structure with dermoid tumors because epidermoid cysts are origin to dermoid cysts. Therefore, these two types of tumor are often grouped together.

Dermoid and epidermoid cysts are both benign tumors, which means that they will not spread to the other parts of the body. However, as the cysts continue to grow, it is possible that the cysts compress nearby structures such as the spinal cord or spinal nerves. Under such condition, the cysts should be removed by surgical procedures.

The main difference between dermoid cysts and epidermoid cysts is that they contain different materials in the cysts. For dermoid cysts, there are skin cells, their products and many other skin components such as hair and sweat glands. While for epidermoid cysts, there may only contain the products of skin cells. Eventually, the cysts may rupture.

Spinal dermoid and epidermoid cysts are both uncommon diseases. Spinal dermoid cysts on the whole account for about 20% of intradural tumors while spinal epidermoid cysts account for only 0.5% to 1% of all spinal tumors. Also, when dermoid cysts happen in the spinal cord, 40% of patients have intramedullary ones while the other 60% of patients have extramedullary ones. Moreover, the disease is most commonly seen in infants and children. According to statistics, as many as 20% of intradural tumors are seen in patients younger than 1-year-old. But the symptoms often do not show themselves until the patients reach the age of 20. What’s more, spinal dermoid and epidermoid cysts affect boys and girls equally.



Symptoms

Spinal dermoid and epidermoid cysts can be congenital or iatrogenic. Congenital cysts often form during fetal development while iatrogenic ones are the result of medical examination and treatment. Since spinal dermoid and epidermoid cysts grow at a slow rate, they often have no symptoms until they have grown to a large size.

Depending on where these cysts are and what size these cysts are, different signs and symptoms may present later. Typically, cysts may cause no pain and they are usually moveable. Other main symptoms may include the following:

  • Headaches
  • Nausea
  • Seizure
  • Vision loss
  • Facial pain
  • Weakness and numbness in the arms, legs, and face
  • Mood changes
  • Trouble walking
  • Loss control over the bowel or bladder

It is worth mentioning that when the cysts rupture, the contents spill and may lead to serious meningitis. In that situation, the following symptoms may arise:

  • Fever
  • Headaches
  • Neck stiffness

As time progresses, the cysts will experience changes in their size, which may cause cosmetic problems. However, in severe conditions, cysts in the skull may be at risk of penetrating into the brain as well.



Diagnosis

If spinal dermoid and epidermoid cysts are suspected, the doctor usually bases diagnosis on imaging tests, which may include the following:

  • Magnetic Resonance Imaging (MRI) scans. With MRI scans, a detailed image of structures inside the body can be seen clearly.
  • Computed tomography (CT) scans. CT scans can provide a clear image of the bone structures in the spine.
  • Magnetic Resonance (MR) imaging. This imaging can provide a detailed image of soft tissues like discs, nerves and the spinal cord.

More often, the imaging tests are done with a contrast dye so that a border and a clear image can be obtained. Based on the results of the imaging tests, the doctor can give an accurate diagnosis and determine the best treatment plan.


Treatment

For dermoid and epidermoid cysts, once the tumors become symptomatic, surgical removal is the primary treatment of choice because the cysts tend to become larger over time and may penetrate through the skull.

Depending on where the cysts are, different surgical options are available:

  • Minimally invasive options.

Due to the development of medical technology, minimally invasive options such as endoscopic transnasal approaches are free to choose now.

  • Microsurgical removal.

In this surgical procedure, the doctor uses a surgical microscope and other instruments to remove the cysts.

  • Laminectomy.

The doctor may choose laminectomy to remove a portion of the back of the spine so as to expose the cysts in the spinal canal.

Normally, if the cysts grow in places that are easily accessible, the surgery may last only less than an hour. Children who receive the operation can go home the same day of surgery.



Keywords: dermoid and epidermoid cysts; dermoid and epidermoid tumors.


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* The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.