Ruptured Conus Medullaris Dermoid Cyst with Fat Droplets in the Central
A 22-year-old male patient was admitted with history of sudden onset urinary retention 7 months back followed by urinary catheterization for the same. Patient was weaned off the urinary catheter in 7 days, following which patient developed urinary incontinence for 6 months. It was not associated with urgency, frequency or burning micturition.\nPatient also noticed low backache for last 7 days before coming to us. Pain was mild, intermittent aching in nature, not radiating to lower limbs and used to relieve with analgesics. No aggravating or relieving factors for low backache.\nOn neurological examination, higher mental functions and cranial nerves were normal. Power was 5/5 at all the joints in all the four limbs. Sensory examination did not reveal any abnormality. Both superficial and deep tendon reflexes were normal. Gait was normal. Straight leg raising test was free on both sides.\nMagnetic resonance imaging (MRI) scan (-) with contrast and fat suppression studies was showing a well circumscribed lesion approximately 5.4×2.1×1.8 cm in the cauda equina inseparable from conus medullaris with fat droplets within the central spinal canal extending up to the medulla. The lesion was iso to hypo intense on T1 and hyperintense on T2 weighted images. There was no significant post contrast enhancement. T1 hyper intense signal is seen scattered throughout the central spinal canal extending upto the medulla. MRI scan on T1 weighted (sagittal view) images showed a mass lesion containing fat peripherally, at the level of conus medullaris and hyperintense fat content in the central canal extending in to the dorsal and cervical spinal cord up to the medulla secondary to rupture of the mass ().\nPatient was operated with D11-L2 laminectomy and near total excision of the lesion. The spinal cord was expanded and myelotomy was done at the conus medullaris. Intraoperatively, the lesion was intramedullary, white cheesy with hair inside. The capsule was densely adherent to the spinal cord, therefore near complete excision was achieved.\nHistopathological examination showed a fibro collagenous cyst wall lined by stratified squamous epithelium. in view of the presence of hair on gross examination the diagnosis of dermoid cyst was given ().\nPatient's low back pain had improved immediately following the surgery. There was no neurological deficit in the lower limbs after the surgery. However patient had persistent urinary incontinence and on clean intermittent self catheterisation at the time of discharge.\nAt 6 month follow-up, patient was relieved of his low back pain with improvement in the bladder functions and weaned off the urinary catheter.