• Barbagallo Giuseppe M V GMV Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy. Electronic address: giuseppebarbagal@hotmai, Massimiliano Maione, Giuseppe Raudino, and Francesco Certo.
• Department of Neurological Surgery, Policlinico "G. Rodolico" University Hospital, Catania, Italy. Electronic address: giuseppebarbagal@hotmail.com.
• World Neurosurg. 2017 Dec 1; 108: 54-61.

BackgroundIntradural epidermoid tumors of the spinal cord are commonly associated with spinal cord dysraphism or invasive procedures. We report the particular relationships between spinal subarachnoid compartments and thoracic intradural-extramedullary epidermoid tumor, highlighting the relevant anatomic changes that may influence microsurgery.MethodsA 40-year-old woman from compressive myelopathy owing to a thoracic epidermoid tumor extending from T3 to T4 and not associated with spina bifida, trauma, previous surgery, or lumbar spinal puncture underwent microsurgical excision. Accurate tumor membrane dissection, respecting spinal arachnoidal compartments, was performed. Reposition of a laminoplasty plateau helped in restoring thoracic spine anatomic integrity.ResultsSafe gross total tumor resection was achieved. Complete neurologic recovery as well as absence of recurrent tumor was documented at 4-year follow-up. A literature review revealed only 2 other cases of "isolated" thoracic spine epidermoid tumor. However, description of the relationship between tumor membranes and spinal subarachnoid compartments was not available in either case.ConclusionsA thorough knowledge of spinal subarachnoid space anatomy is helpful to distinguish between tumor membranes and arachnoidal planes and to achieve a safe and complete resection to avoid recurrences.Copyright © 2017 Elsevier Inc. All rights reserved.

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