Subtotal resection of an intradural mature teratoma in an adult presenting with difficulty initiating micturition.
BACKGROUND
Teratomas are tumors comprised of tissues from all three germ layers. Teratomas within the spine are exceedingly rare especially in the absence of either spinal dysraphism, congenital abnormalities of the spine, spinal surgery, or history of lumbar punctures. Virchow was the first to describe this occurrence in the spine in 1863 and since then, only a handful of cases have been reported.


METHODS
A 41-year-old male presented with a longstanding history of difficulty initiating micturition and lower back pain with recent onset of saddle paraesthesia and bilateral leg pain. He did not have a history suggestive of spinal trauma nor congenital abnormalities. Neurological examination was unremarkable. Magnetic resonance imaging (MRI) confirmed the presence of an intradural extra axial lesion in the region of the cauda equine. At surgery, the lesion was found to be densely adherent to the conus and a subtotal resection was performed. Histological examination confirmed the lesion to be a mature teratoma. Postoperatively, he made a good recovery and there is no evidence of recurrence at one year follow-up.


CONCLUSIONS
This case demonstrates that a teratoma without immature elements can be subtotally excised to reduce the risk of neurological morbidity.
Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia.
Maria Kristina
MK
Vanguardia
Department of Neurosurgery, Sir Charles Gairdner Hospital and Department of Neurosurgery, Royal Perth Hospital, Perth, Western Australia.
Stephen
S
Honeybul
Division of Tissue Pathology, PathWest QEII Medical Centre Nedlands, Western Australia.
Peter
P
Robbins
Extramedullary; intradural; spinal tumor; teratoma