title: Conus Medullaris Teratoma with Utilization of Fiber Tractography: Case Report.
abstract: Objective Conus medullaris teratomas are very rare tumors. Traditional preoperative diagnosis depended on the findings from magnetic resonance imaging (MRI). Tractography is a novel technique that has recently been utilized to diagnose spinal cord lesions. This case report shows that fiber tractography has great potential in preoperative diagnosis and postoperative follow-up of teratomas of the conus medullaris. Methods A 50-year-old man with a conus medullaris teratoma underwent tractography with the aim of visualizing the tumor in relation to the white matter tracts. The patient underwent a T12-L2 laminectomy, and the lesion was resected. The histopathology diagnosis was of a mature teratoma. Study Design Case report. Results Diffusion tensor imaging (DTI) and tractography provide more details about the white matter tracts in relation to space-occupying lesions that may be more sensitive than conventional MRI and have recently been utilized in spinal cord lesions. Fiber tracking has the ability to visualize the integrity of the white matter tracts at the level of the conus medullaris in relation to the lesion. The tracts appeared to be displaced by the lesion at the conus medullaris. Tractography also showed no white matter tracts within the lesion. Such findings are consistent with the characteristics of a benign lesion. Exploiting tractography in this case was helpful in predicting the nature of the lesion preoperatively and in planning the surgical intervention. Conclusions Conus medullaris teratomas mostly affect adults. Patients generally present with a long history of clinical symptoms prior to diagnosis. Surgery is required for diagnosis, and the goal should be complete tumor excision without sacrificing any neurologic functions. The use of DTI and tractography, in addition to conventional MRI, has the potential to be very valuable for the diagnosis, surgical planning, and follow-up of patients with conus medullaris teratomas.
authors.affiliation: Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada ; Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Fahad
authors.initials: F
authors.lastname: Alkherayf
authors.affiliation: Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Orthopedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Spine Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
authors.forename: Abdullah Faisal
authors.initials: AF
authors.lastname: Arab
authors.affiliation: Spine Program, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada ; Division of Neurosurgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
authors.forename: Eve
authors.initials: E
authors.lastname: Tsai
keywords: conus medullaris; diffusion-weighted images; intramedullary tumor; teratoma; tractography