Accidental conus medullaris injury following combined epidural and spinal anesthesia in a pregnant woman with unknown tethered cord syndrome

In most adults, the conus medullaris ends at around the inferior margin of the first lumbar （L1） vertebral body.However, location of terminus of the conus medullaris is variable and even extends more distally in patients with diseases such as tethered cord syndrome （TCS）. Here, we reported a conus medullaris injury following combined spinal and epidural anesthesia （CSEA） in a pregnant woman with unknown TCS.

Spinal intradural mature teratoma in an elderly patient

Spinal intradural mature teratomas are rarely encountered in adults.In this report,one of the oldest patients ever reported to harbor an intradural mature teratoma of the conus medullaris is presented,and the relevant literature concerning the teratoma’s origin,clinical presentation,radiological features,and treatment modalities is reviewed.A previously healthy 70-year-old woman presented with a 2-month history of left sciatica.Her neurological examination was normal and the magnetic resonance imaging of the thoracolumbar spine showed an intradural,partially cystic mass extending from T12 to L3 level.The patient underwent a T11-L4 laminectomy.After opening the dura,a yellowish vascular tumor attached to the conus medullaris came into view.Meticulous dissection allowed for subtotal tumor removal.Only a thin part of the tumor wall,tightly attached to the conus medullaris,was left.The tumor was diagnosed as mature teratoma by histological study,and no adjunctive therapy was administered.The pain experienced by the patient disappeared postoperatively.Her condition remained unchanged with no radiological recurrence through the most recent follow-up examination,3 years after surgery.The present study outlines that mature teratoma can arise from the conus medullaris,even in older adult patients.Functional preservation is of utmost importance,and long-term follow-up is mandatory to spot recurrences early.