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Year : 2010  |  Volume : 58  |  Issue : 5  |  Page : 738-739

Unusual intradural extramedullary tuberculoma of the spinal cord in childhood

Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu, China

Date of Acceptance11-Oct-2010
Date of Web Publication28-Oct-2010

Correspondence Address:
Jie Duan
Department of Neurosurgery, West China Hospital of Sichuan University, 37 Guo Xue Xiang, Wu Hou District, Chengdu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.72201

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How to cite this article:
Duan J, Mao B. Unusual intradural extramedullary tuberculoma of the spinal cord in childhood. Neurol India 2010;58:738-9

How to cite this URL:
Duan J, Mao B. Unusual intradural extramedullary tuberculoma of the spinal cord in childhood. Neurol India [serial online] 2010 [cited 2022 Aug 7];58:738-9. Available from: https://www.neurologyindia.com/text.asp?2010/58/5/738/72201


A 14-year-old female patient was admitted with progressive weakness of both the lower limbs of 2 weeks duration with abrupt inability to use both the limbs. She had been diagnosed as a case of tuberculosis meningitis (TBM), 2 months prior to this admission, and was on antituberculous treatment (ATT). Neurologic examination revealed 0/5 motor power in the lower limbs with a sensory level at T2. Magnetic resonance imaging (MRI) of spine showed a circumscribed intradural extramedullary mass at the level of vertebra T2 and T3 [Figure 1]. She underwent emergency T1-T3 laminectomy and total excision of the mass. On opening the dura, there was a grayish, moderately vascular granulomatous lesion in the intradural extramedullary plane, which could not be easily separated from the thoracic cord, and perilesional edema and congestion was noted too [Figure 2]. Pathological examination confirmed a tuberculous granuloma [Figure 3]. Postoperatively, she received intravenous pulse methylprednisolone therapy for 5 days and ATT was continued. At 3-months follow-up, she could walk with assistance.
Figure 1: Sagittal T1-weighted (a) and T2-weighted (b) MRI of cervicothoracic spine. Intradural extramedullary shuttle-like mass at the level of junction of vertebra T2 and T3 with compression of spinal cord

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Figure 2: Intraoperative photograph showing an extramedullary granuloma lesion with about 1.5-cm diameter

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Figure 3: Photomicrograph showing granuloma comprising macrophages, lymphocytes and Langhan's giant cells (H and E, ×100)

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Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a presentation of tuberculosis, and exclusively described in patients antecedent history of TBM. [1] Till date, only three children with IETSC have been reported [Table 1]. [2],[3],[4] Of the four children with IETSC, including the present child, in three children, IETSC occurred weeks after TBM despite effective ATT. This clinical process has been recognized as a paradoxical reaction, which is believed to be the result of an interaction between the host's immunity and the direct effects of mycobacterial products. In adults with IETSC, no gender difference has been observed; all the reviewed children with IETSC were boys. [1] This may be related to higher incidence of TBM in boys. Subacute spinal cord compression with motor and sensory findings are the most ordinary manifestations. [1] The insidious nature and gradual progression of the IETSCs often result in delay in diagnosis. In our patient, the abrupt worsening in the weakness may be related to vascular compromise caused by the inflammation surrounding the vessels in the subarachnoid space. The most frequent location was thoracic spine. In our opinion, the tuberculous bacilli that reach the spinal cord through the subarachnoid space are trapped in a relatively narrow thoracic spinal canal, producing a local inflammatory response and subsequent development of IETSC. MRI is the imaging modality of choice. Prompt medical and surgical treatment is recommended for the IETSCs with space-occupying effects. [1] The use of corticosteroid is also reasonable, but there are not yet clinical trials to assess this aspect. Permanent neurological deficit is a common sequela and was present in all the reviewed pediatric cases.
Table 1: Summary of pediatric cases with IETSC

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 » References Top

1.Luo L, Pino J. An intradural extramedullary tuberculoma of the spinal cord in a non-HIV-infected patient: Case report and review of the literature. Lung 2006;184:187-93.   Back to cited text no. 1
2.Garcia Allut A, Gelabert Gonzalez M, Bollar Zabala A, MartinezRumo R, Reyes Santias R. Intradural extramedullary tuberculoma of spinal cord. J Neurosurg Sci 1985;29:113-5.  Back to cited text no. 2
3.Mathuriya SN, Khosla VK, Banerjee AK. Intradural extramedullary tuberculous spinal granulomas. Clin Neurol Neurosurg 1988;90:155-8.  Back to cited text no. 3
4.Akhaddar A, El Hassani MY, Gazzaz-Rifi M, Chakir N, El Khamlichi A, Jiddane M. MR imaging in the diagnosis of intradural extramedullary tuberculoma. Report of a case and review of the literature. J Neuroradiol 2000;27:107-11.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1]

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