Dermoid Cyst

A Spinal Dermoid Cyst is a rare, benign, congenital tumor that develops from embryonic skin cells trapped during the formation of the spinal cord. These cysts are often composed of skin elements like hair follicles, sebaceous glands, fat, and keratin debris, and they can occur anywhere along the spinal canal — most commonly in the lumbosacral region. Though benign, dermoid cysts grow slowly and may remain asymptomatic for years. However, as they enlarge, they can compress the spinal cord or nerves, resulting in pain, weakness, bladder issues, scoliosis, or neurological deficits. 🌍 Bangladesh Perspective In Bangladesh, spinal dermoid cysts are often misdiagnosed or discovered late due to a lack of advanced imaging facilities in rural areas and limited awareness among general physicians. Children may present with paraparesis, abnormal gait, or foot deformities without proper diagnosis. At the National Institute of Neurosciences & Hospital (NINS) and Bangladesh Paediatric Neurocare Centre, Dr. Md. Nafaur Rahman is leading the way in diagnosing and surgically treating these rare spinal lesions using microsurgical techniques, intraoperative neuromonitoring, and child-centric rehabilitation protocols. 🧬 Causes and Pathology Congenital origin: due to inclusion of ectodermal elements during neural tube closure May be associated with spinal dysraphism like: Dermal sinus tracts Tethered cord Spina bifida Rarely, dermoid cysts can rupture, leading to chemical meningitis 🧒 Clinical Presentation Symptoms depend on the size and location of the cyst, typically in the lumbar or sacral spine: Back pain or stiffness Lower limb weakness or spasticity Abnormal gait or frequent falls Foot deformities (e.g., clubfoot, cavus foot) Urinary or bowel incontinence Recurrent spinal infections in cases with associated dermal sinus tract Hairy patch, skin dimple, or lipoma over lower spine In some cases, the cyst is incidentally discovered during imaging for other concerns. 🔍 Diagnosis 🧠 MRI Spine – Gold Standard Shows the extent, composition, and location of the cyst Detects associated anomalies: tethered cord, sinus tracts, lipomas 🧪 CT Scan Can detect calcifications or fat density within the cyst Useful pre-surgically for bony involvement 🧫 Sinogram or MRI with contrast Helpful if dermal sinus tract is present to assess communication 🛠️ Treatment Strategy The treatment of choice for symptomatic dermoid cyst is complete surgical excision. Early surgery prevents irreversible neurological damage and complications like infection or cyst rupture. ✂️ Microsurgical Excision Careful removal of the cyst wall and contents under high magnification Preservation of nerve roots and spinal cord integrity Intraoperative neuromonitoring is used to avoid neurological injury ⚠️ Important Considerations If complete excision is not possible due to adherence to neural tissue, subtotal removal may be done with close monitoring Dermal sinus tracts, if present, must be excised entirely to prevent infection 🔄 Postoperative Outcome Most children experience significant improvement in: Motor function Pain relief Bladder control Gait and posture Long-term outcomes are excellent when diagnosed and operated early. Follow-up includes serial MRIs to monitor for recurrence, especially in partially excised cases. ⚕️ Complications If Left Untreated Progressive paralysis or weakness Permanent bladder/bowel dysfunction Spinal deformity (scoliosis) Rupture of cyst causing meningitis Recurrent infections via dermal sinus 👨‍⚕️ Why Trust Dr. Md. Nafaur Rahman? Expert in rare pediatric spinal tumors and spinal dysraphism Experienced in microsurgical cyst excision with nerve-sparing techniques Operates at NINS – Bangladesh’s premier neurosurgery hospital Runs a dedicated multidisciplinary team for child neurorehabilitation Known for providing compassionate and high-quality care to children from all corners of Bangladesh 📞 For Serial or Consultation Dr. Md. Nafaur Rahman Assistant Professor, Department of Pediatric Neurosurgery, National Institute of Neurosciences & Hospital (NINS) Chief Consultant, Bangladesh Paediatric Neurocare Centre 📞 Call Now: 01912988182 | 01607033535 🌐 Visit: www.neurosurgeonnafaur.com