Spinal Epidermoids - Rare Tumours Posing a Diagnostic Dilemma

Spinal epidermoids are rare tumors comprising less than 1% of all intraspinal tumors. These tumors are usually found as intramedullary space occupying lesions (SOLs) in cervico-dorsal and as intradural SOLs in lumbo-sacral region. Thier origin has been advocated to be congenital or acquired. These tumors have been reported in patients of age group 03 yrs to 55 yrs in various case reports/small series in literature. The usual presentation is that of slowly progressive spastic paraparesis / quadriparesis with or without sphincter involvement as in IMSOLs / IDEMs lesions of the spinal cord. These tumors pose a diagnostic dillema due to there rarity. The diagnosis of these tumors may be delayed as they have similar symptoms and signs as in any other intradural spinal patholgy. The preoperative diagnosis can be made with reasonable certainity dedicated MRI sequences (diffusion weighted & ADC) are carried out. Since these tumors are benign, an early diagnosis gives the patient a realtively good prognosis. We report two such unusual cases which came as diagnostic surprise on operative table and that too within a period of 06 months. Microscopic total excision relatively early in the course of the illness in both these patients had satisfactory outcome with good neurological recovery and no recurrence over last 24 months