Intracranial epidermoid cysts, also known as “pearloma” or “cholesteatoma”, are developed by the transfer of epithelial tissue into the neural tube during the 3-5 weeks of embryonic neural tube closure. Intramedullary epidermoid cysts are relatively rare. Today, based on a recent document, we will learn about this disease and its treatment with everyone. Recently, “SpinalIntramedullaryEpidermoidCyst:CaseReportandUpdatedLiteratureReview” (Spinal Intramedullary Epidermoid Cyst: Case Report and Latest Literature Review) was published in “WorldNeurosurgery”. The article reported a case of chest intramedullary epidermoid cyst and used PubMed database to evaluate this disease. Review it. Epidermoid cyst is a rare benign tumor in the nerve axis, accounting for about 1% of tumors in the spinal canal. The cause can be congenital or acquired. As a slow-growing tumor, its clinical manifestations vary greatly with the location, size, or age of the patient’s lesion. The results suggest that in most cases, surgical resection is the treatment for this disease. The low recurrence rate can significantly change the quality of life of patients, so total resection should be our goal. Description of a case in the article: patient, male, 47 years old. Last year, I went to the doctor with back pain and progressive spastic paraplegia. Disorders of both lower limbs were scored 4/5 at the proximal end and 3/5 at the distal end. Proprioceptive ataxia and bilateral asymmetric pyramidal syndrome were observed. The patient can walk with the aid of the assist device. Upon examination, there were no signs of skin on the patient’s back. Magnetic resonance imaging (MRI) of the thoracic spine and lumbar spine showed intramedullary masses at the level of the 11th thoracic spine with T1-weighted low signal and T2-weighted high signal (Figure 1). During the operation, after two-level laminectomy and dural incision, a cystic pale yellow intramedullary tumor was found (Figure 2). A total resection was performed, but due to the strong adhesion to the nerve structure, part of the capsule was left in place. After the operation, the patient was safe and was discharged 10 days after the operation. The histopathological report confirmed the epidermoid cyst (Figure 3). Follow-up 1 month after surgery, the patient’s leg coordination has been slightly improved, and can walk autonomously with a walking frame. In the discussion part of the article, reviewing numerous literature data explained various aspects of spinal epidermoid cyst. Spinal cord epidermoid cyst is a rare benign tumor. However, there may be malignant changes. There are a few cases reported in the intracranial area, but only one case of squamous cell carcinoma in the spine. In the literature review of pathogenesis, we found a bimodal age distribution (incidence rate), the largest peak occurs in childhood (0-10 years), and the second peak occurs around 35 years old. This bimodal distribution can be partially explained. Pathogenesis. Epidermoid cysts are produced when epidermal cells are abnormally translocated into the neural tube. This situation may occur during embryonic development, that is, the neural tube is abnormally closed and encapsulated abnormal epidermal cells. In this case, it is usually associated with spinal dysplasia, such as spina bifida, scoliosis, and skin or skin defects. We found that as many as 25% of patients have spinal dysplasia, the most common abnormality is spina bifida, followed by furry sinuses. On the other hand, Choremis et al. first reported the iatrogenic origin of epidermoid cysts in 1956. Since then, the mechanism by which skin fragments enter the spinal canal through lumbar puncture has been fully demonstrated. Our study found that 38% of patients had undergone spinal surgery, which may be the cause of tumors. Signs and symptoms As a slow-growing tumor, the onset of signs and symptoms is insidious. In the literature we reviewed, the time delay for diagnosis was about 2 years. In most cases, it starts with non-specific back pain and continues to show various symptoms depending on the location of the tumor. Symptoms of motor weakness or myelopathy are often present. However, there are also cases of acute attacks. The first case described by Deogaonkar et al. described acute paraplegia caused by an epidermoid cyst. treatment method surgical resection is the preferred treatment method. If nerve function is preserved, the purpose of surgery should be total resection. Most researchers choose laminectomy, while others undergo laminoplasty. some researchers
Elastic intramedullary nails are currently the most popular fixation method for the treatment of long bone fractures in children. As far as the trend of trauma orthopedics treatment is concerned, closed reduction intramedullary nail fixation is often used for adult long bone fractures. The fixation of adult fracture intramedullary nails has also achieved extremely satisfactory clinical results. Therefore, children’s orthopedics also want to draw on the treatment methods of adult orthopedics and apply intramedullary nail technology to treat children’s long bone fractures. Elastic intramedullary needle technology came into being. Elastic intramedullary needles are usually treated with general anesthesia. Manipulative reduction of fractures, select the appropriate intramedullary needle and pre-bend, determine the entry point, avoid injury to the epiphysis, opening, insert the elastic intramedullary needle, and use the good elastic recovery force to maintain the stability of fracture reduction through the fractured end . Let me introduce you to some knowledge of elastic intramedullary needles. 1. What is an elastic intramedullary needle? The elastic intramedullary needle is also called titanium alloy elastic needle. Children’s elastic intramedullary needle technology first originated in France. Because of its small trauma and good clinical effect, it is rapidly popularized around the world. The fixing principle is to use the good elastic restoring force of titanium alloy to convert the force acting on the bone into pressure and thrust through the three contact points of the medullary cavity, so that the fracture is reduced, and there is enough force to resist the reduction position of the fracture. Because of its minimally invasive and good clinical effect, the elastic intramedullary needle technology has become another artifact for orthopedic surgeons to treat long tubular bones in children, and is known as the gift of God to children with long bone fractures. 2. What are the indications of elastic intramedullary needles? The technique of elastic intramedullary nail fixation, like all fixation techniques, has certain indications. Not all fractures in children are suitable for the application of elastic intramedullary nails. Children’s elastic intramedullary nails are mainly used to treat transverse and short oblique fractures and long-range fractures of the long bones of the limbs of children aged 3 to 13 years. The age of obese children needs to be appropriately reduced. Weight-loss children can relax their age appropriately, usually requiring children to weigh no more than 50 kg. 3. What are the contraindications of elastic intramedullary needles? The elastic intramedullary nail is not suitable for intra-articular fractures, nor for completely unstable forearm fractures and lower limb fractures without any cortical support, especially those who need weight bearing and older. 4. What are the advantages of elastic intramedullary nails? The elastic intramedullary nail fixation method is currently a popular minimally invasive concept. The fixation method is both precise and minimally invasive. It is a true fish and bear paw. Closed reduction during surgery is conducive to the protection of the local periosteal and soft tissue of the fracture. During the operation, the blood flow damage to the fractured end is significantly reduced, which is beneficial to fracture healing. The point of entry of the elastic needle to avoid the epiphysis during surgery will not affect the development of children’s epiphysis. Early postoperative weight-bearing is beneficial to functional exercise and fracture healing. The surgical incision is small, the scar is small, and removal is relatively simple. In short, the elastic intramedullary needle has the advantages of less trauma, no damage to the epiphysis, simple operation technology, reliable fixation of fracture, and short hospitalization time. 5. How long is the elastic intramedullary needle usually fixed? & nbsp. The removal time of the elastic intramedullary needle depends on the fracture healing. Generally it needs to be fixed for 3 to 6 months. In summary, the elastic intramedullary needle technique provides a safe, effective, and minimally invasive treatment method for children with long bone fractures. With the popularization and promotion of elastic intramedullary needle technology, it will surely benefit more children. Doctor Yao Jinghui, the Third Affiliated Hospital of Southern Medical University (Guangdong Orthopedics Hospital, Guangdong Orthopedics Research Institute), hopes to help everyone’s health!