spinal cord teratomas are uncommon . excluding sacrococcygeal teratoma in neonates , teratomas in the spinal canal are rare . only a few central nervous system(cns )
delayed presentation of spinal teratomas has generally been associated with its slow - growing characteristics5 ) .
dermoid tumors may rupture and fatty material may escape into the subarachnoid space , and/or ventricles , resulting in variable neurological symptoms6 ) .
the symptoms are dependent on location and are due to the irritative effect on and/or compression of the adjacent structures3 )
aseptic meningitis may also occur15 ) . here , we report a rare case of a mature intradural spinal teratoma in an adult with concomitant additional intracranial lipid droplet dissemination associated with neurologic deterioration after iatrogenic rupture of the cyst portion occurs .
iatrogenic rupture of cystic portion during spinal teratoma surgery may worsen intracranial lesion that previously exist .
a 67-year - old man was transferred to our department from the urology department of our hospital .
he complained of nocturia and frequent urination . during evaluation , an approximately 3 cm mass in the spinal canal
abdominal ct imaging showed a fat - containing mass with mural calcification at the l2 level ( fig .
the patient looked ill and had experienced aplastic anemia 2 years previously . on neurologic examination , an approximately grade 4 weakness was noted in both lower extremities .
lumbar magnetic resonance ( mr ) imaging showed a hyperintense intradural mass on a t1-weighted image .
after gadolinium enhancement , there was no significant enhancement of the mass in the conus medullaris and focal enhancement of the distal soft tissue component ( fig .
after surgery , his lower - extremity weakness did not improve , and he could not walk without assistance .
preoperative ct imaging showed low density lesion in both lateral ventricle and cistern . at that time
postoperative brain mr imaging showed hyperintense lesion on a t1-weighted image on both the lateral ventricle and as well as slightly enlarged ventricles ( fig .
we performed extra ventricular drainage ( evd ) , and his mental status recovered temporarily .
however , his mental status again declined ; evd was performed on the other side after 7 days but , we could not retrieve tissue from the mass . during treatment ,
spinal cord teratomas are uncommon . only a few cns teratomas arise from the spinal cord .
the prognosis of teratoids is poor and metastases at diagnosis are common , especially in neonates and children4 ) .
teratomas are slow growing , but , often grow outside the spinal column and extend to the paraspinal and retroperitoneal spaces .
mature teratomas are composed of well - differentiated elements , and immature teratomas are primitive elements derived from any or all of the three germ cell layers2 ) . mr imaging is considered as the gold standard for the detection of teratomas .
total resection is desirable ; however , it is almost impossible because of the intimal adhesion between the teratomatous cyst and the circumferential nervous parenchyma .
radical surgery is not recommended as the pathology is benign and recurrence rates are low even after subtotal resections1,11 ) .
the surgical goal is subtotal resection for decompressing the cord and resecting the exophytic component5 ) , and excised tissues should be taken as extensively as possible to establish an accurate diagnosis7 ) .
after subtotal resection , consecutive and long - term radiological follow - up is recommended16 ) .
a case of spinal mature teratoma accompanying the intracranial dissemination of fatty droplets has been reported3,6,13,15 ) .
dissemination of lipid droplets within ventricles occurs because of spontaneous , iatrogenic , or traumatic rupture .
our case is similar to this previous case , although , an intracranial mass lesion was not confirmed histopathologically .
the symptoms of intracranial lipid droplet dissemination were headache , chemical meningitis , seizure and mental deterioration .
the cystic contents gain access to the ventricular system by way of retrograde flow through the foramen of luschka and magendie15 ) .
it is possible that the central canal can serve as a pathway for ruptured material into the brain13 ) .
ct and mr imaging are useful in diagnosing free fat in the subarachnoid space and intraventricular fat - fluid level .
lipid is differentiated from cerebrospinal fluid by negative values ( -20 to -130 hounsfield units)15 ) .
mr imaging is reliable in the evaluation of the presence of rupture and its extent in the subarachnoid spaces or into the central spinal canal10 ) .
we report a rare case of a mature intradural spinal teratoma and concomitant intracranial lipid droplet dissemination in an adult . additional lipid droplet dissemination to intracranial space with neurologic deterioration after a spinal teratoma surgery should be considered when iatrogenic rupture of the cyst portion occurs .
it might develop the symptom and worsen hydrocephalus , although asymptomatic lipid droplets dissemination was previously existed before lumbar spine surgery .
 a teratoma is a neoplasm that contains tissues originating from three germ cell layers at ectopic sites . 
 the embryology of teratomas remains unclear . 
 teratomas are usually composed of cystic and solid components , and they are usually associated with syringomyelia . 
 cystic lesions of teratomas may rupture in a spontaneous , iatrogenic , or traumatic manner . 
 lipid droplets in the ventricles and subarachnoid space are rare . 
 we managed a case of a spinal teratoma in the lumbar region in a 67-year - old man . 
 he complained of nocturia , frequent urination , and difficulty in walking for 2 months . 
 radiographic imaging revealed a lumbar spinal intradural mass . 
 intracranial lipid droplets dissemination was also existed . 
 the patient underwent surgery , and a diagnosis of mature teratoma was confirmed histopathologically . during the operation , the cystic portion of the intradural mass ruptured . during the hospital 
 stay , the patient 's mental status declined . on radiological examination , slightly enlarged ventricle size was observed . 
 dissemination of lipid droplets within ventricles occurs because of spontaneous , iatrogenic , or traumatic rupture . 
 additional lipid droplet dissemination to the intracranial space associated with neurologic deterioration after a spinal teratoma surgery should be considered when iatrogenic rupture of the cyst portion occurs . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION