Rare tumor of conus medullaris in an adult with a favorable outcome.

Sir, A 44-year-old female presented to us with a history of nocturnal, continuous, and burning dysesthetic low back pain radiating to both lower limbs for the last three months. There were no bladder or bowel complaints. She had a normal neurological examination apart from reduced sensations in the L5 dermatome in both lower limbs. Magnetic Resonance Imaging (MRI) of the lumbar spine showed a well-circumscribed, solid-cystic conus lesion, which was hypointense on T1-weighted images and hyperintense on T2-weighted images, along with peripheral contrast enhancement and an associated rostral syrinx [Figure 1]. The rest of the spine was normal. Her urodynamics revealed low voiding pressures with significant abdominal straining, characteristic of lower motor neuron type of dysfunction. She underwent D11-L2 laminotomy and gross total excision of the tumor. Intraoperatively, the cyst was associated with a grayish solid moderately vascular component [Figure 2], which was adherent to the cord at some places. It was removed piecemeal without the use of an ultrasonic aspirator and almost the entire specimen was sent for pathology. Postoperative recovery was uneventful. Histopathology showed a biphasic pattern of compactly arranged bipolar cells with loose piloid cells, suggestive of pilocytic astrocytoma [Figure 3]. The patient is still under follow-up and has no recurrence to date.