title: Intraspinal epidermoid tumor of the cauda equina region: seven cases and a review of the literature.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  To investigate the clinical features and surgical outcomes of patients with intraspinal epidermoid tumor of the cauda equina region.
  
  
  BACKGROUND
  Intraspinal epidermoid tumor of the cauda equina region is very rare, and the majority of the existing literature of this condition comprises case reports with a few case series.
  
  
  METHODS
  The clinical features and surgical outcomes of 7 patients (2 males, 5 females; age range, 4-66 y) with intraspinal epidermoid tumor of the cauda equina region were retrospectively studied, and a literature review was performed. All patients complained of neurologic symptoms and underwent microscope-assisted surgery. The mean duration of postoperative follow-up was 126 months (range, 52-209 mo).
  
  
  RESULTS
  Antecedent lumbar puncture had been performed on 3 patients, and 4 cases thought to be of congenital origin without a past history of lumbar puncture had no associated anomalies, such as spina bifida or dermal sinus. Postoperatively, complications occurred in 3 patients concerning cauda equina symptom. Two patients (29%) had tumor recurrence, diagnosed 1 and 13 years after surgery, respectively. Immediately after additional surgery for tumor recurrence, both patients had severe paresis of the hemilateral foot.
  
  
  CONCLUSIONS
  Complete removal without tear of the tumor was difficult in our case series, because the capsule of the tumor was thin and often adhered to the cauda equina nerve roots or dura mater. However, total resection of the capsule is important, because patients with epidermoid tumor are at risk for recurrence. On the other hand, aggressive resection of the capsule adhering to the neural elements can cause a high rate of neurological complications postoperatively, especially after surgery for tumor recurrence.
authors: Department of Orthopaedic Surgery, Osaka Rosai Hosipital, Osaka, Japan. m1908130@msic.med.osaka-cu.ac.jp
authors: Masahiro
authors: M
authors: Morita
authors: Akira
authors: A
authors: Miyauchi
authors: Shinya
authors: S
authors: Okuda
authors: Takenori
authors: T
authors: Oda
authors: Hiroyuki
authors: H
authors: Aono
authors: Motoki
authors: M
authors: Iwasaki