Epidermoid Cyst of the Lumbar Spine After Lumbar Puncture: A Clinical, Radiographic, and Pathologic Correlation

Authors

Vincent Dodson, Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Neil Majmundar, Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.Follow
Leroy R. Sharer, Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
John L. Gillick, Departments of Neurological Surgery and Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA. Electronic address: jg1388@rutgers.edu.

Document Type

Article

Abstract

BACKGROUND: Epidermoid cysts can rarely arise as a late complication of lumbar puncture. We describe a young man who had a remote history of a lumbar puncture and who was subsequently found to have a lumbar spinal epidermoid cyst on imaging, after presenting with lower extremity radicular pain. CASE DESCRIPTION: A 24-year-old man with a remote history of lumbar puncture presented with lower back pain and radicular leg pain which had been ongoing for over a year. Despite conservative management, the patient's symptoms progressed to worsening back pain and left L4 radiculopathy. Magnetic resonance imaging of the lumbar spine demonstrated a peripherally enhancing, intradural, extramedullary lesion at L4-5. Diffusion-weighted imaging revealed diffusion restriction within the lesion, characteristic of an epidermoid cyst. The patient underwent an L4-5 laminectomy for resection of the intradural tumor. The lesion was noted to contain pearly white granules consistent with the appearance of an epidermoid cyst. Histopathology confirmed the diagnosis. On follow-up examination, the patient demonstrated improvement of his back pain and resolution of radicular symptoms. CONCLUSIONS: Lumbar spinal epidermoid cysts may be either congenital or secondary to an iatrogenic cause. This patient had a remote history of lumbar puncture during workup for meningitis as a child. As a complication of a lumbar puncture, the formation of an epidermoid cyst can occur and is thought to be the result of implanted cutaneous tissue. This case provides a comprehensive illustration of the clinical, radiographic, intraoperative, and pathologic findings consistent with an iatrogenic epidermoid cyst.

Medical Subject Headings

Central Nervous System Diseases (diagnostic imaging, etiology, pathology, surgery); Diffusion Magnetic Resonance Imaging; Epidermal Cyst (diagnostic imaging, etiology, pathology, surgery); Humans; Iatrogenic Disease; Laminectomy; Low Back Pain (etiology); Lumbar Vertebrae (diagnostic imaging, surgery); Magnetic Resonance Imaging; Male; Postoperative Complications (diagnostic imaging, etiology, pathology, surgery); Radiculopathy (etiology); Spinal Canal; Spinal Puncture (adverse effects); Young Adult

Publication Date

5-1-2020

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

137

First Page

363

Last Page

366

PubMed ID

32058114

Digital Object Identifier (DOI)

10.1016/j.wneu.2020.02.008

Recommended Citation

Dodson, Vincent; Majmundar, Neil; Sharer, Leroy R.; and Gillick, John L., "Epidermoid Cyst of the Lumbar Spine After Lumbar Puncture: A Clinical, Radiographic, and Pathologic Correlation" (2020). Neurosurgery. 2196.
https://scholar.barrowneuro.org/neurosurgery/2196