What are the other Names for this Condition? (Also known as/Symptoms)

• Dermoid Cyst of Spine
• Intraspinal Dermoid Cyst
• Spinal Intramedullary Dermoid Cyst

What is Spinal Dermoid Cyst? (Definition/Background Information)

• Spinal Dermoid Cyst is a benign slow-growing tumor that usually involves the lower part of the spinal cord. It usually consists of a single cyst filled with sebaceous material. A dermoid cyst has only hair, skin, and adnexal structures in the cyst wall and contents
• In general, a dermoid cyst may be described as a type of mature cystic teratoma. A teratoma is a rare tumor that arises from the germ cells. Teratomas are typically classified as either mature teratomas or immature teratomas
• The cause of formation of a Spinal Dermoid Cyst is unknown. Also, presently, the risk factors for the same are not well-established. This extremely rare cystic tumor form is usually seen in children; it is believed to develop during pregnancy, in the fetal stage
• Small-sized Spinal Dermoid Cysts may not present any significant signs and symptoms; however, large tumors may cause back pain, numbness, weakness of the lower extremities, or loss of bladder/bowel control
• In some cases, the treatment of Spinal Dermoid Cyst may involve surgery. In most cases, the prognosis is excellent with appropriate early treatment, since it is a benign tumor. However, some tumors may undergo a malignant transformation. In such cases, the prognosis depends upon several factors including on the tumor stage

Who gets Spinal Dermoid Cyst? (Age and Sex Distribution)

• Spinal Dermoid Cysts are highly uncommon tumors that represent much less than 1% of all intramedullary tumors of the spinal cord (i.e., tumors arising from inside the spinal canal)
• These cystic tumors are mostly observed in children up to 10 years old. Many are known to be present from birth. In children, these constitute about 8% of all intraspinal tumors
• Both males and females are affected
• No specific racial or ethnic group predilection is noted

What are the Risk Factors for Spinal Dermoid Cyst? (Predisposing Factors)

• Currently, no definite risk factors have been identified for Spinal Dermoid Cysts
• It is reported that in some cases, the cyst is observed in the presence of other congenital spinal cord abnormalities such as spina bifida

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Spinal Dermoid Cyst? (Etiology)

The cause of development of Spinal Dermoid Cyst is generally unknown. Research scientists have proposed the following to explain the cause of formation of Dermoid Cysts of Spinal Cord:

• Congenital factors: It is believed that abnormal differentiation of germ cells gives rise to the formation of a dermoid cyst, due to accumulation of skin and adnexal structures. This occurs while the baby is in the mother’s womb
• Spinal Dermoid Cysts are known to be associated with a congenital condition called spinal dysraphism, a broad term to encompass spinal defects that take place during early fetal development

It is important to note that the condition is not caused by what the expectant mother does or does not do, either prior to or during pregnancy.

What are the Signs and Symptoms of Spinal Dermoid Cyst?

The signs and symptoms of Spinal Dermoid Cyst can vary from one individual to another and depends on the size and location of the cystic tumor. In general, small tumors may be asymptomatic and no significant symptoms observed, while large tumors are known to present symptoms. Rarely, a sudden onset of symptoms may be observed from rupture of the dermoid cyst, spilling its contents within the spinal column. This can result in major complications and adversely affect the prognosis.

Most of the tumors are found in the lumbar-sacral region (lower back), affecting the spinal canal. These cystic tumors may be intramedullary (from inside the spinal canal) or extramedullary (from outside the spinal canal). Occasionally, some tumors may involve the thoracic region (upper back) and cervical spine (neck region).

The signs and symptoms of Spinal Dermoid Cyst may rarely include any of the following:

• Presence of visible lump in the affected region
• Back pain and/or chest pain
• Numbness and tingling sensation
• Weakness of the body or lower extremities; loss of strength in the arms of legs
• Pain in the arms and legs, depending on the nerves that are compressed by the tumor
• Spinal cord compression leading to numbness and pain, due to mass effect of the tumor
• Severe cases may result in loss of bowel and bladder control
• Paralysis

In some cases, the presence of other coexistent congenital spinal anomalies may be noted.

How is Spinal Dermoid Cyst Diagnosed?

There are a variety of tests the healthcare provider may employ to diagnose Spinal Dermoid Cyst, which may include:

• Physical examination and complete medical history screening
• Assessment of the presenting signs and symptoms
• Neurological, motor skills, and cognitive assessment:
  • Checking intellectual ability, memory, mental health and function, language skills, judgment and reasoning, coordination and balance, reflexes, and sensory perceptions (space, sight, hearing, touch, etc.)
  • The healthcare provider/neurologist may use the Karnofsky Performance Scale in order to assess the neurological functioning of the individual’s central nervous system (CNS)
• Electroencephalography (EEG)
• Electromyography with nerve conductivity tests
• Imaging studies that may be performed include:
  • X-ray of the vertebral column
  • Computerized tomography (CT) scan of the vertebral column; CT with contrast
  • Magnetic resonance imaging (MRI) scan of the central nervous system; MRI with contrast agents such as gadolinium
  • Cerebral angiographic studies or MR angiography: An angiogram involves injecting dye into the bloodstream, which makes the blood vessels to appear visually on X-rays. The X-ray may show a tumor in the blood vessels leading into the tumor
  • Magnetic resonance spectroscopy: This radiological technique is used to study the chemical profile of the tumor. It is often performed with and compared to corresponding MRI scan images of the affected region
• Cerebrospinal fluid analysis, where a spinal tap or lumbar puncture procedure may be performed: This diagnostic test is used to remove a sample of cerebrospinal fluid (CSF) from the spaces in and around the spinal cord. The sample is removed from the lower spinal cord using a thin needle, and it is then checked for the presence of cancer cells
• Molecular studies, if necessary

Tissue biopsy: A biopsy of the affected region (spinal cord) is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy sample under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy sample under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis.

A differential diagnosis to eliminate other conditions or tumor types may be considered, before arriving at a definitive diagnosis.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Spinal Dermoid Cyst?

The complications of Spinal Dermoid Cyst may include the following:

• Stress and anxiety due to fear of the tumor
• Large tumor masses may get secondarily infected with bacteria or fungus
• Tumor rupture and torsion: Usually, larger tumors are more prone for torsion
• Severe complications may arise from underlying spinal abnormalities, if present
• Occasionally, recurrence of the tumor following its incomplete surgical removal
• Some teratomas are known to transform to malignancies; the most common cancer arising from a mature cystic teratoma is squamous cell carcinoma
• Damage to the muscles, vital nerves, and blood vessels, during surgery
• Post-surgical infection at the wound site is a potential complication

How is Spinal Dermoid Cyst Treated?

The treatment of Spinal Dermoid Cyst may involve the following:

• In some cases of small tumors with slow-growing rates, the healthcare provider may propose conservative ‘wait and watch’ measures, instead of immediately recommending surgery to remove them
• Generally, the treatment of choice is a complete surgical excision for all such tumors (mature or immature teratomas). The surgeon may use certain microsurgical approaches to remove the cyst
• Additionally, chemotherapy and/or radiation therapy may be necessary for malignant tumors
• Follow-up care with regular screening and check-ups are important and encouraged

How can Spinal Dermoid Cyst be Prevented?

Currently, there are no known methods to prevent the development of a Spinal Dermoid Cyst.

What is the Prognosis of Spinal Dermoid Cyst? (Outcome/Resolutions)

• The prognosis of Spinal Dermoid Cyst is usually excellent with complete surgical removal of the tumor, since it is a benign tumor
• In case of a malignant transformation of a mature benign cystic tumor to a cancerous teratoma, the prognosis depends on several factors including on the stage of the tumor

Additional and Relevant Useful Information for Spinal Dermoid Cyst:

The following article link will help you understand other cancers and benign tumors:

http://www.dovemed.com/diseases-conditions/cancer/