{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:07:14Z","timestamp":1776096434310,"version":"3.50.1"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,2,2]]},"abstract":"\n BACKGROUND<\/jats:title>\n Lumbosacral dermoid cysts are rare pathological entities, particularly among adults, and can be challenging to diagnose because of nonspecific clinical symptoms and variable MRI characteristics. In this patient, the importance of including dermoid cysts in the differential diagnosis of lumbosacral intradural lesions, even in older patients, is highlighted.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 65-year-old woman presented with a 3-year history of progressive low back pain radiating to the left buttock and gait disturbance. She underwent mediastinal schwannoma resection under general anesthesia 22 years ago. Lumbar spinal MRI revealed an intradural mass lesion extending from the L2 to L5 levels with high and iso-hyperintense signals on T1- and T2-weighted images, respectively. The lesion was heterogeneously enhanced with gadolinium contrast. CT demonstrated calcifications at the L5 level. Without establishing a preoperative diagnosis, surgery was performed. Intraoperatively, a brownish capsule containing hair follicles and sebaceous material was dissected and removed from the lumbar enlargement and surrounding nerve roots. A small portion of the tumor remained inside of the conus medullaris. Postoperative MRI confirmed near-complete tumor resection, and the patient experienced symptomatic improvement. Histological analysis confirmed the diagnosis of dermoid cyst.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Dermoid cysts typically contain hair, sebaceous material, and calcifications. Their capsule may adhere firmly to the spinal cord or nerve roots. Careful surgical manipulation is essential to prevent injury and subsequent chemical meningitis. Preoperative recognition of this pathology is crucial for surgical planning, patient counseling, and minimizing intraoperative risks. Awareness of this rare condition in older patients can lead to more accurate preoperative diagnosis and improved clinical outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25883<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25883","type":"journal-article","created":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T13:30:11Z","timestamp":1770298211000},"source":"Crossref","is-referenced-by-count":0,"title":["Challenges in diagnosing and treating lumbosacral dermoid cyst in an older patient: illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Brahma Putra","family":"Juliansyah","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"},{"name":"Department of Neurosurgery, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6712-672X","authenticated-orcid":true,"given":"Kyohei","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiharu","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel Willyarto","family":"Anugerah","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"},{"name":"Department of Neurosurgery, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taketo","family":"Nishizawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2967-8125","authenticated-orcid":true,"given":"Ahmad","family":"Faried","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Faculty of Medicine Universitas Padjadjaran, Bandung, West Java, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haruo","family":"Kanno","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Tohoku Medical and Pharmaceutical University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiki","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"6","key":"bib1","series-title":"Surg Neurol","first-page":"477","article-title":"Epidermoid tumors. Review of the literature","volume":"29","author":"Netsky","year":"1988","unstructured":"Netsky MG.Epidermoid tumors. Review of the literature. Surg Neurol. 1988;29(6):477-483."},{"issue":"3","key":"bib2","series-title":"J Neurosci Rural Pract","first-page":"495","article-title":"Spinal dermoid and epidermoid cyst: an institutional experience and clinical insight into the neural tube closure models","volume":"12","author":"Maurya","year":"2021","unstructured":"Maurya VPSingh YSrivastava AKSpinal dermoid and epidermoid cyst: an institutional experience and clinical insight into the neural tube closure models. J Neurosci Rural Pract. 2021;12(3):495-503."},{"key":"bib3","series-title":"World Neurosurg","first-page":"e438","article-title":"Clinical presentation and surgical outcomes based on age and tumor topography in 59 patients with spinal dermoid cysts","volume":"151","author":"Sarkar","year":"2021","unstructured":"Sarkar SRajshekhar V.Clinical presentation and surgical outcomes based on age and tumor topography in 59 patients with spinal dermoid cysts. World Neurosurg. 2021;151:e438-e446."},{"issue":"4","key":"bib4","series-title":"Ann Med Res","first-page":"0667","article-title":"Spinal dermoid and epidermoid tumors: clinical series of 15 cases","volume":"25","author":"Cavus","year":"2018","unstructured":"Cavus GIstemen IAcik VSpinal dermoid and epidermoid tumors: clinical series of 15 cases. Ann Med Res. 2018;25(4):0667-0672."},{"issue":"5","key":"bib5","series-title":"J Clin Neurosci","first-page":"712","article-title":"Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region","volume":"19","author":"Liu","year":"2012","unstructured":"Liu HZhang JNZhu T.Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region. J Clin Neurosci. 2012;19(5):712-717."},{"issue":"11","key":"bib6","series-title":"Acta Neurochir (Wien)","first-page":"2895","article-title":"Intraspinal epidermoid and dermoid cysts-tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome","volume":"162","author":"Siller","year":"2020","unstructured":"Siller SEgensperger RSzelenyi ATonn JCZausinger SSchichor C.Intraspinal epidermoid and dermoid cysts-tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome. Acta Neurochir (Wien). 2020;162(11):2895-2903."},{"key":"bib7","series-title":"Int J Surg Case Rep","first-page":"52","article-title":"A rare case of intramedullary spinal dermoid cyst in adult: a case report","volume":"73","author":"Gatam","year":"2020","unstructured":"Gatam LMerthana PE.A rare case of intramedullary spinal dermoid cyst in adult: a case report. Int J Surg Case Rep. 2020;73:52-57."},{"key":"bib8","series-title":"World Neurosurg","first-page":"e395","article-title":"Spinal dermoid cyst with spontaneous rupture into the syrinx cavity alone","volume":"118","author":"Liu","year":"2018","unstructured":"Liu TDeng XXu YXin Y.Spinal dermoid cyst with spontaneous rupture into the syrinx cavity alone. World Neurosurg. 2018;118:e395-e404."},{"key":"bib9","series-title":"World Neurosurg","first-page":"448","article-title":"Spinal intradural extramedullary dermoid cyst","volume":"134","author":"Khalighinejad","year":"2020","unstructured":"Khalighinejad FHajizadeh MMokhtari ARakhshan RHajizadeh MRezvani M.Spinal intradural extramedullary dermoid cyst. World Neurosurg. 2020;134:448-451."},{"issue":"4","key":"bib10","series-title":"Childs Nerv Syst","first-page":"659","article-title":"A review on five cases of intramedullary dermoid cyst","volume":"30","author":"Suocheng","year":"2014","unstructured":"Suocheng GYazhou X.A review on five cases of intramedullary dermoid cyst. 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J Neuroimaging. 2013;23(1):71-74."},{"key":"bib13","series-title":"J Clin Neurosci","first-page":"247","article-title":"Dermoid cysts of the conus medullaris: clinical review, case series and management strategies","volume":"50","author":"Aoun","year":"2018","unstructured":"Aoun SGLiu MAStill MEl Ahmadieh TYTamimi MAGluf W.Dermoid cysts of the conus medullaris: clinical review, case series and management strategies. J Clin Neurosci. 2018;50:247-251."},{"issue":"6","key":"bib14","series-title":"Neuroradiol J","first-page":"759","article-title":"Rupture of a spinal dermoid cyst may lead to dissemination and progress of Fatty tissue in the central spinal canal and intracranial subarachnoid space. A case report","volume":"27","author":"Kabbasch","year":"2014","unstructured":"Kabbasch CDorn FMpotsaris AWeber CLiebig T.Rupture of a spinal dermoid cyst may lead to dissemination and progress of Fatty tissue in the central spinal canal and intracranial subarachnoid space. A case report. Neuroradiol J. 2014;27(6):759-763."},{"issue":"6","key":"bib15","series-title":"Neurosurgery","first-page":"765","article-title":"Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging","volume":"23","author":"Graham","year":"1988","unstructured":"Graham DVTampieri DVillemure JG.Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging. Neurosurgery. 1988;23(6):765-767."},{"issue":"3","key":"bib16","series-title":"Iran J Neurosurg","first-page":"179","article-title":"Dermoid cysts of conus medullaris","volume":"4","author":"Ghadarjani","year":"2018","unstructured":"Ghadarjani SAlijani BNaseri AHamzei A.Dermoid cysts of conus medullaris. Iran J Neurosurg. 2018;4(3):179-188."},{"issue":"938","key":"bib17","series-title":"Br J Radiol","first-page":"167","article-title":"Ruptured spinal dermoid cyst with disseminated intracranial fat droplets","volume":"79","author":"Cha","year":"2006","unstructured":"Cha JGPaik SHPark JSPark SJKim DHLee HK.Ruptured spinal dermoid cyst with disseminated intracranial fat droplets. Br J Radiol. 2006;79(938):167-169."},{"issue":"4","key":"bib18","series-title":"J Neurosurg","first-page":"666","article-title":"Intraventricular fat from a ruptured sacral dermoid cyst: clinical, radiographic, and pathological correlation. Case report","volume":"78","author":"Scearce","year":"1993","unstructured":"Scearce TAShaw CMBronstein ADSwanson PD.Intraventricular fat from a ruptured sacral dermoid cyst: clinical, radiographic, and pathological correlation. Case report. J Neurosurg. 1993;78(4):666-668."},{"issue":"3","key":"bib19","series-title":"J Neurosurg Spine","first-page":"361","article-title":"Isolated central canal rupture of spinal dermoid. Report of 3 cases","volume":"21","author":"Garg","year":"2014","unstructured":"Garg KKumar R.Isolated central canal rupture of spinal dermoid. Report of 3 cases. J Neurosurg Spine. 2014;21(3):361-366."},{"issue":"3","key":"bib20","series-title":"AJNR Am J Neuroradiol","first-page":"583","article-title":"The many faces of myxopapillary ependymomas","volume":"46","author":"Hutuca","year":"2025","unstructured":"Hutuca IEgervari KLMerkler DVargas MI.The many faces of myxopapillary ependymomas. AJNR Am J Neuroradiol. 2025;46(3):583-588."},{"issue":"2","key":"bib21","series-title":"Acta Neurol Belg","first-page":"541","article-title":"A giant cervicothoracic cord lipoma: an uncommon finding","volume":"117","author":"Organji","year":"2017","unstructured":"Organji HRajabkhah SFatehi F.A giant cervicothoracic cord lipoma: an uncommon finding. Acta Neurol Belg. 2017;117(2):541-543."},{"issue":"1","key":"bib22","series-title":"Spinal Cord","first-page":"34","article-title":"Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients","volume":"43","author":"Sandalcioglu","year":"2005","unstructured":"Sandalcioglu IEGasser TAsgari SFunctional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients. Spinal Cord. 2005;43(1):34-41."},{"issue":"3","key":"bib23","series-title":"J Neurooncol","first-page":"251","article-title":"Post-operative radiotherapy for recurrent dermoid cysts of the spine: a report of 3 cases","volume":"33","author":"Bristow","year":"1997","unstructured":"Bristow RGLaperriere NJTator CMilosevic MWong CS.Post-operative radiotherapy for recurrent dermoid cysts of the spine: a report of 3 cases. J Neurooncol. 1997;33(3):251-256."},{"issue":"6","key":"bib1","series-title":"Surg Neurol","first-page":"477","article-title":"Epidermoid tumors. Review of the literature","volume":"29","author":"Netsky","year":"1988","unstructured":"Netsky MG.Epidermoid tumors. Review of the literature. Surg Neurol. 1988;29(6):477-483."},{"issue":"3","key":"bib2","series-title":"J Neurosci Rural Pract","first-page":"495","article-title":"Spinal dermoid and epidermoid cyst: an institutional experience and clinical insight into the neural tube closure models","volume":"12","author":"Maurya","year":"2021","unstructured":"Maurya VPSingh YSrivastava AKSpinal dermoid and epidermoid cyst: an institutional experience and clinical insight into the neural tube closure models. J Neurosci Rural Pract. 2021;12(3):495-503."},{"key":"bib3","series-title":"World Neurosurg","first-page":"e438","article-title":"Clinical presentation and surgical outcomes based on age and tumor topography in 59 patients with spinal dermoid cysts","volume":"151","author":"Sarkar","year":"2021","unstructured":"Sarkar SRajshekhar V.Clinical presentation and surgical outcomes based on age and tumor topography in 59 patients with spinal dermoid cysts. World Neurosurg. 2021;151:e438-e446."},{"issue":"4","key":"bib4","series-title":"Ann Med Res","first-page":"0667","article-title":"Spinal dermoid and epidermoid tumors: clinical series of 15 cases","volume":"25","author":"Cavus","year":"2018","unstructured":"Cavus GIstemen IAcik VSpinal dermoid and epidermoid tumors: clinical series of 15 cases. Ann Med Res. 2018;25(4):0667-0672."},{"issue":"5","key":"bib5","series-title":"J Clin Neurosci","first-page":"712","article-title":"Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region","volume":"19","author":"Liu","year":"2012","unstructured":"Liu HZhang JNZhu T.Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region. J Clin Neurosci. 2012;19(5):712-717."},{"issue":"11","key":"bib6","series-title":"Acta Neurochir (Wien)","first-page":"2895","article-title":"Intraspinal epidermoid and dermoid cysts-tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome","volume":"162","author":"Siller","year":"2020","unstructured":"Siller SEgensperger RSzelenyi ATonn JCZausinger SSchichor C.Intraspinal epidermoid and dermoid cysts-tumor resection with multimodal intraoperative neurophysiological monitoring and long-term outcome. Acta Neurochir (Wien). 2020;162(11):2895-2903."},{"key":"bib7","series-title":"Int J Surg Case Rep","first-page":"52","article-title":"A rare case of intramedullary spinal dermoid cyst in adult: a case report","volume":"73","author":"Gatam","year":"2020","unstructured":"Gatam LMerthana PE.A rare case of intramedullary spinal dermoid cyst in adult: a case report. Int J Surg Case Rep. 2020;73:52-57."},{"key":"bib8","series-title":"World Neurosurg","first-page":"e395","article-title":"Spinal dermoid cyst with spontaneous rupture into the syrinx cavity alone","volume":"118","author":"Liu","year":"2018","unstructured":"Liu TDeng XXu YXin Y.Spinal dermoid cyst with spontaneous rupture into the syrinx cavity alone. World Neurosurg. 2018;118:e395-e404."},{"key":"bib9","series-title":"World Neurosurg","first-page":"448","article-title":"Spinal intradural extramedullary dermoid cyst","volume":"134","author":"Khalighinejad","year":"2020","unstructured":"Khalighinejad FHajizadeh MMokhtari ARakhshan RHajizadeh MRezvani M.Spinal intradural extramedullary dermoid cyst. World Neurosurg. 2020;134:448-451."},{"issue":"4","key":"bib10","series-title":"Childs Nerv Syst","first-page":"659","article-title":"A review on five cases of intramedullary dermoid cyst","volume":"30","author":"Suocheng","year":"2014","unstructured":"Suocheng GYazhou X.A review on five cases of intramedullary dermoid cyst. Childs Nerv Syst. 2014;30(4):659-664."},{"issue":"1","key":"bib11","series-title":"Asian Spine J","first-page":"50","article-title":"Ruptured conus medullaris dermoid cyst with fat droplets in the central canal","volume":"7","author":"Sharma","year":"2013","unstructured":"Sharma MMally RVelho V.Ruptured conus medullaris dermoid cyst with fat droplets in the central canal. Asian Spine J. 2013;7(1):50-54."},{"issue":"1","key":"bib12","series-title":"J Neuroimaging","first-page":"71","article-title":"Magnetic resonance imaging of ruptured spinal dermoid tumors with spread of fatty droplets in the central spinal canal and\/or spinal subarachnoidal space","volume":"23","author":"Zhang","year":"2013","unstructured":"Zhang YCheng JLZhang LMagnetic resonance imaging of ruptured spinal dermoid tumors with spread of fatty droplets in the central spinal canal and\/or spinal subarachnoidal space. J Neuroimaging. 2013;23(1):71-74."},{"key":"bib13","series-title":"J Clin Neurosci","first-page":"247","article-title":"Dermoid cysts of the conus medullaris: clinical review, case series and management strategies","volume":"50","author":"Aoun","year":"2018","unstructured":"Aoun SGLiu MAStill MEl Ahmadieh TYTamimi MAGluf W.Dermoid cysts of the conus medullaris: clinical review, case series and management strategies. J Clin Neurosci. 2018;50:247-251."},{"issue":"6","key":"bib14","series-title":"Neuroradiol J","first-page":"759","article-title":"Rupture of a spinal dermoid cyst may lead to dissemination and progress of Fatty tissue in the central spinal canal and intracranial subarachnoid space. A case report","volume":"27","author":"Kabbasch","year":"2014","unstructured":"Kabbasch CDorn FMpotsaris AWeber CLiebig T.Rupture of a spinal dermoid cyst may lead to dissemination and progress of Fatty tissue in the central spinal canal and intracranial subarachnoid space. A case report. Neuroradiol J. 2014;27(6):759-763."},{"issue":"6","key":"bib15","series-title":"Neurosurgery","first-page":"765","article-title":"Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging","volume":"23","author":"Graham","year":"1988","unstructured":"Graham DVTampieri DVillemure JG.Intramedullary dermoid tumor diagnosed with the assistance of magnetic resonance imaging. Neurosurgery. 1988;23(6):765-767."},{"issue":"3","key":"bib16","series-title":"Iran J Neurosurg","first-page":"179","article-title":"Dermoid cysts of conus medullaris","volume":"4","author":"Ghadarjani","year":"2018","unstructured":"Ghadarjani SAlijani BNaseri AHamzei A.Dermoid cysts of conus medullaris. Iran J Neurosurg. 2018;4(3):179-188."},{"issue":"938","key":"bib17","series-title":"Br J Radiol","first-page":"167","article-title":"Ruptured spinal dermoid cyst with disseminated intracranial fat droplets","volume":"79","author":"Cha","year":"2006","unstructured":"Cha JGPaik SHPark JSPark SJKim DHLee HK.Ruptured spinal dermoid cyst with disseminated intracranial fat droplets. Br J Radiol. 2006;79(938):167-169."},{"issue":"4","key":"bib18","series-title":"J Neurosurg","first-page":"666","article-title":"Intraventricular fat from a ruptured sacral dermoid cyst: clinical, radiographic, and pathological correlation. Case report","volume":"78","author":"Scearce","year":"1993","unstructured":"Scearce TAShaw CMBronstein ADSwanson PD.Intraventricular fat from a ruptured sacral dermoid cyst: clinical, radiographic, and pathological correlation. Case report. J Neurosurg. 1993;78(4):666-668."},{"issue":"3","key":"bib19","series-title":"J Neurosurg Spine","first-page":"361","article-title":"Isolated central canal rupture of spinal dermoid. Report of 3 cases","volume":"21","author":"Garg","year":"2014","unstructured":"Garg KKumar R.Isolated central canal rupture of spinal dermoid. Report of 3 cases. J Neurosurg Spine. 2014;21(3):361-366."},{"issue":"3","key":"bib20","series-title":"AJNR Am J Neuroradiol","first-page":"583","article-title":"The many faces of myxopapillary ependymomas","volume":"46","author":"Hutuca","year":"2025","unstructured":"Hutuca IEgervari KLMerkler DVargas MI.The many faces of myxopapillary ependymomas. AJNR Am J Neuroradiol. 2025;46(3):583-588."},{"issue":"2","key":"bib21","series-title":"Acta Neurol Belg","first-page":"541","article-title":"A giant cervicothoracic cord lipoma: an uncommon finding","volume":"117","author":"Organji","year":"2017","unstructured":"Organji HRajabkhah SFatehi F.A giant cervicothoracic cord lipoma: an uncommon finding. Acta Neurol Belg. 2017;117(2):541-543."},{"issue":"1","key":"bib22","series-title":"Spinal Cord","first-page":"34","article-title":"Functional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients","volume":"43","author":"Sandalcioglu","year":"2005","unstructured":"Sandalcioglu IEGasser TAsgari SFunctional outcome after surgical treatment of intramedullary spinal cord tumors: experience with 78 patients. Spinal Cord. 2005;43(1):34-41."},{"issue":"3","key":"bib23","series-title":"J Neurooncol","first-page":"251","article-title":"Post-operative radiotherapy for recurrent dermoid cysts of the spine: a report of 3 cases","volume":"33","author":"Bristow","year":"1997","unstructured":"Bristow RGLaperriere NJTator CMilosevic MWong CS.Post-operative radiotherapy for recurrent dermoid cysts of the spine: a report of 3 cases. 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