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Spinal dermoid-epidermoid lesions constitute less than 1% of all spinal tumors. These lesions are usually congenital and they usually have unique signal characteristics on magnetic resonance imaging. Here we present 5 adult patients with spinal dermoid and epidermoid tumors who had a very long duration of clinical history. It is widely accepted that prudent surgery might avoid neurologic aggravation, but it would bring a high probability of recurrence. Therefore, total surgical extirpation with microsurgical techniques should be preferred. Subtotal excision may be an alternative strategy when the capsule is adherent to adjacent neural structures.