A case of vascular malformation on the cervico-thoracic level of spinal cord localized by selective spinal angiography is reported. The patient was treated surgically by ligadure of the "feeder" vessel. Following surgery the patient gradually improved and ten months later returned to his full activity. The diagnostic and surgical importance of spinal angiography and its contribution to the morphological study of the spinal cord vascular malformations is enphasized. Spinal angiography gives the most accurate information as to the size and extent of the malformation and also the precise location of the "feeder" vessels. Direct operation upon the spinal cord with removal or oblitations of vessels or ligadure of the feeder vessels are the best procedures. The advantages and limitations of both surgical methods are discussed. Total excision is best done under the operating microscope, being essential the use of the bipolar coagulator. The authors feel that the surgical results will be more impressive when spinal angiography will be easily available as to permit earlier diagnosis and surgery before the development of important neurological deficits.

São relatados dois casos de tumores epidermóides e um de tumor dermóide, todos intrarraquianos. Este último era de localização epidural ao nível da coluna torácica (caso 3); os dois tumores epidermóides situavam-se na coluna tóraco-lombar (caso 1) e lombar (caso 2), respectivamente, sendo o primeiro intramedular e o segundo intradural. Em dois casos (casos 2 e 3) os tumores associavam-se a fístula dérmica congênita. Um paciente (caso 3) foi operado aos dois meses de idade; a descoberta do tumor deveu-se à realização da raquimanometria que revelou bloqueio, apesar do paciente não apresentar qualquer sinal neurológico de compressão medular. Os autores são de opinião que, em presença de fístula dérmica congênita ao nível da coluna vertebral, principalmente quando localizada acima do segmento lombosacro, deve-se sempre suspeitar da possibilidade do tumor epidermóide ou dermóide intrarraquiano, mesmo na ausência de sinais neurológicos. A combinação de sintomas neurológicos de longa duração, a evidência radiológica de erosão e alargamento do canal raquiano e a história de fístula dérmica congênita proporcionaram o diagnóstico pré-operatório correto no caso 2.

Two cases of epidermoids and one case of dermoid intraspinal tumours are reported. The last case was located at thoracic level (T7) (case 3) and was epidural in localization. The two epidermoids tumours were located at the thoracic-lumbar (case 1) and lumbar (case 2) level, respectively; the first was intramedullary and the second subdural in localization. In two (cases 2 and 3) there was associated communicating pilonidal sinuses. One of the patients (case 3) was operated within the second month of age. The early discovery of the tumour in this patient was made through a lumbar raquimanometry that disclosed a complete subarachnoid block. In spite of this the patient did not presented any neurological symptoms. The authors are of opinion that in presence of a dermal fistula higher to lumbo-sacral spinal segment one must have in mind the possibility of intraspinal epidermoid or dermoid tumour, even in absence of neurological symptoms. The combination of long term clinical symptoms, radiographic evidence of pressure erosion, enlargement of the spinal canal and pilonidal sinus led to the correct preoperative diagnosis in case 2.