Dermoid and Epidermoid Cyst

Pediatric spinal dermoid and epidermoid cysts are rare congenital tumors of the spine that result from abnormal embryological development. These benign lesions can lead to spinal cord compression, progressive neurological symptoms, and disability if not diagnosed and treated early. Although non-cancerous, their growth within the spinal canal can cause significant neurological impairment. In Bangladesh, such spinal cysts in children are often overlooked or misdiagnosed due to a lack of awareness and inadequate access to specialized imaging and pediatric neurosurgery. Dr. Md. Nafaur Rahman, one of the most trusted names in pediatric neurosurgery in Bangladesh, provides precise diagnosis and expert microsurgical treatment for these rare but critical spinal disorders. What are Dermoid and Epidermoid Cysts? Both dermoid and epidermoid cysts are congenital inclusion tumors: Epidermoid cysts contain only squamous epithelial cells and keratin debris. Dermoid cysts contain skin adnexal structures such as hair follicles, sebaceous glands, and even teeth in rare cases. These cysts arise due to incomplete separation of skin and neural tissue during embryogenesis, often associated with spinal dysraphism or dermal sinus tracts. Common Locations in the Spine Lumbosacral region (most common) Thoracic or cervical spine (less common) Intradural extramedullary space (within the dura but outside the spinal cord) May also be associated with tethered cord syndrome or spina bifida occulta Causes and Risk Factors Congenital origin – due to defective neural tube closure during fetal development Acquired cases – secondary to repeated lumbar punctures (extremely rare in children) Often associated with: dermal sinus tracts, spina bifida, or other neural tube defects Signs and Symptoms In Bangladesh, children may present late with symptoms that progressively worsen over time: Back pain or discomfort Weakness in legs or gait disturbances Numbness or tingling in lower limbs Loss of bladder or bowel control Scoliosis or spinal deformity Visible skin changes over lower back – dimple, hair tuft, sinus tract, or cystic swelling If a dermoid cyst ruptures, it can lead to chemical meningitis, causing acute neurological symptoms and fever. Diagnostic Approach Dr. Md. Nafaur Rahman follows an internationally accepted diagnostic protocol, adapted to the context of pediatric care in Bangladesh. 1. Clinical Examination Neurological assessment Evaluation of cutaneous markers of spinal dysraphism Urinary and bowel function assessment 2. Imaging Investigations MRI with contrast – gold standard for identifying cyst type, size, location, and spinal cord compression Spinal ultrasound – used in neonates when MRI is unavailable CT scan – for bony anatomy or complex cases Surgical Treatment The only definitive treatment is microsurgical excision of the cyst, ideally performed before irreversible neurological damage occurs. Goals of Surgery: Total removal of the cyst contents and wall Preservation of normal spinal cord and nerve function Untethering of the spinal cord, if associated Prevention of recurrence Dr. Nafaur Rahman’s Expertise: Utilizes microscope-assisted microsurgery for maximum precision Employs intraoperative neuromonitoring to preserve neural structures Repairs associated dermal sinus tracts to prevent future infections Offers postoperative neuro-rehabilitation and urological care for holistic recovery Prognosis Excellent outcome if treated early Long-term prognosis depends on the preoperative neurological status Risk of recurrence if the cyst wall is incompletely removed Lifelong follow-up is recommended for detecting retethering or recurrence Challenges in Bangladesh Delayed recognition of symptoms in rural and semi-urban areas Confusion with abscesses or simple back lumps Lack of pediatric MRI access outside major hospitals Limited awareness among general pediatricians and primary care providers Social stigma around congenital disorders Why Trust Dr. Md. Nafaur Rahman? One of the few pediatric neurosurgeons in Bangladesh with deep expertise in spinal congenital lesions Treats complex dermoid/epidermoid cases with minimal surgical morbidity Works at NINS, the premier neurosurgical institution, and Bangladesh Paediatric Neurocare Centre, a leading private center Offers comprehensive care, including neuro-urology, child neurology, and rehabilitation services Dedicated to affordable, accessible, and compassionate care for children across Bangladesh Contact for Appointment Dr. Md. Nafaur Rahman Assistant Professor, Pediatric Neurosurgery National Institute of Neurosciences & Hospital (NINS) Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 For Serial/Appointment: 01912988182 | 01607033535 🌐 Website: www.neurosurgeonnafaur.com