Intramedullary Teratomas: Two Case Reports and a Review of the Literature

Abstract

Objective: Intramedullary teratomas are extremely rare tumours. A review of the literature found only reports of 59 cases, three of which were treated by us. The most common localisation for these tumours is in the medullary conus. According to our experience as well as more recent reports, MRI images allow a preoperative diagnosis to be made. Clinical Presentation: We treated two cases of intramedullary teratoma of the conus: that of a 41-year-old woman and that of a 40-year-old man. Both suffered from motor and sensory disorders, and the woman also suffered from urinary disorders. CT and MRI enabled us to diagnose an intramedullary tumour and to suspect a dysembryogenic origin. Intervention: Both patients were treated surgically; the surgical removal of the tumour was extensive but not total because of the tenacious adhesions of the tumour to the adjacent parenchyma. Conclusion: Surgery is the therapy of choice in cases of intramedullary teratomas; the removal, though incomplete, leads to a definite improvement of symptoms. In our two cases the follow-up has been 7 years and 6 years, respectively. No tumour regrowth occurred during this period.

Zusammenfassung

Gegenstand und Bedeutung: Bei intramedullären Teratomen handelt es sich um äußerst seltene Tumoren. In der bestehenden Fachliteratur wird von 59 Fällen berichtet. Drei dieser Fälle wurden von uns behandelt. Am häufigsten wird der Tumor am Conus medullaris lokalisiert. Gemäß unserer Erfahrungen und anhand neuerer Fälle ermöglichen MRI-Bilder eine präoperative Diagnose. Klinische Präsentation: Wir stellen zwei Fälle eines intramedullären Teratomas des Conus dar: Dabei handelt es sich um eine 41-jährige Frau und einen 40-jährigen Mann. Beide litten unter motorischen und sensorischen Funktionsstörungen. Im Falle der Frau kamen Harnbeschwerden hinzu. CT und MRI ermöglichen uns die Diagnose eines intramedullären Tumors mit dem Verdacht einer dysembryogenetischen Neoplasie. Intervention: Beide Patienten wurden chirurgisch behandelt. Ein großer Teil des Tumors wurde operativ entfernt. Eine vollständige Entfernung war, wegen der hartnäckigen Verwachsungen des Tumors mit dem angrenzenden Parenchym, nicht möglich. Schlussfolgerung: Im Falle eines intramedullären Teratoms ist der chirurgische Eingriff die bevorzugte Therapie. Selbst die nicht vollständige Entfernung des Tumors führt zu einer definitiven Verbesserung der Krankheitssymptome. In den von uns behandelten Fällen betrug die Katamnese 7 bzw. 6 Jahre. In diesem Zeitraum konnte kein erneutes Tumorwachstum festgestellt werden.

Key words

spinal cord - intramedullary tumour - teratoma

Schlüsselwörter

Rückenmark - intramedullärer Tumor - Teratom

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