PMC7568090_01
Noncontrasted and contrasted preoperative sagittal and coronal magnetic resonance imaging of the lumbar spine demonstrating well-circumscribed intradural, extramedullary lesion at the L2 and L3 level, measuring 3.76 x 1.25 x 1.56 cm, from the right to left that is hyperintense on T2 and STIR but isointense on T1 but with peripheral enhancement on T1 postcontrast. Note the displacement from the right to left the cauda equine nerve roots.
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F1
All findings were consistent with an epidermoid cyst resulting in displacement right to left of the conus/cauda equina [Figure 1].
Microsurgical resection of epidermoid cyst (a) dural opening with displaced nerve roots and capsule of the tumor, (b) approach of the capsular portion and initiation of the debulking, (c) lesion with friable content, poorly vascularized with multiple adhesions to adjacent nerve roots, (d) total resection of the lesion without compromising nerve roots.
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F2
The lesion was nonvascularized, grayish, pearly, and friable with a well-defined capsule that was not adherent to the surrounding nerve roots of the cauda equina (i.e., more right sided) which was fully resected [Figure 2].
Microscopic image demonstrating the fibrous capsular portion, the keratinized stratified squamous epithelium as well as the keratin content without cutaneous attachments (H&E) (x40).
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F3
The histopathology revealed fibrous capsule with a flat, stratified keratinized epithelium with keratin sheets extending toward its lumen without any skin attachments, these findings were compatible with an epidermoid cyst [Figure 3].