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case_images: Lumbosacral MRI of the patient preoperatively done sagittal T2 image demonstrating hyperintense lesion extending from L2-L4.
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case_images: Contrast-enhanced lumbosacral magnetic resonance imaging (MRI) showed type 1 (T1) hypointense and T2 hyperintense, 6 cm cranio-caudally and 2 cm antero-posteriorly, expansile lesions that extended from L2-L4 with involvement of the conus and cauda equina (see Figure 1).
case_images: (A-D) Intraoperative picture demonstrating tumor after dural opening and myelotomy, tumor samples and complete tumor removal.
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case_images: Intraoperatively, the mass anchored the conus intradurally, filling the spinal canal and displacing the caudal roots anteriorly and laterally, with adherence to the nerve roots on each aspect from L2-L4 (Figure 2C-D).
case_images: Postoperative control lumbosacral MRI demonstrating complete tumor excision.
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case_images: A postoperative lumbosacral MRI confirmed near total excision (see Figure 3).
case_images: Histopathology microscopic pictures demonstrating keratin flakes, fibrous cyst wall lined by stratified squamous epithelium, chronic inflammatory infiltrates within the cyst wall and a cyst lumen.
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case_images: The jelly-like cyst content and its wall were sent for histopathological examination, which confirmed a fragmented fibrous cyst wall coated through maturing stratified squamous cells with scattered keratin flecks and fragments of bland skeletal muscle and adipose tissue, which are typical of epidermoid cysts (Figure 4).