Ruptured intracranial dermoid cysts

BACKGROUND

Intracranial dermoid cysts are rare congenital neoplasms that are believed to arise from ectopic cell rests incorporated in the closing neural tube. The rupture of an intracranial dermoid cyst is a relatively rare event that typically occurs spontaneously. In the past it was believed that rupture is always fatal, a hypothesis that is not supported by more recently reported cases. The symptoms associated with rupture vary from no symptoms to sudden death.

METHODS

The present paper analyzes published cases of ruptured intracranial dermoid cysts in terms of their age profile and their clinical presentation and describes an additional case.

RESULTS

Analysis of published cases revealed headache (14 out of 44 patients; 31.8%) and seizures (13 out of 44 patients; 29.5%), to be the most common signs of rupture followed by, often temporary, sensory or motor hemisyndrome (7 out of 44 patients; 15.9%), and chemical meningitis (3 out of 44 patients; 6.9%).

CONCLUSION

Headache occurred primarily in younger patients (mean age 23.5 ± 9.3 years), whereas seizures primarily occurred in older patients (mean age 42.8 ± 11.3 years). The patients with sensory or motor hemisyndrome associated with rupture of an intracranial dermoid cyst showed a more homogeneous age distribution (mean age 38.4 ± 23.5 years).     

Ruptured intracranial dermoid cysts

Summary Rupture of intracranial dermoid cysts (RICDC) is a rare phenomenon. The mechanism of rupture, pathophysiology of fat in the ventricles and subarachnoid spaces, possible complications, and proper management of such conditions are proposed on the basis of a review of the literature and experience with two cases of ruptured intracranial dermoid cysts (One was in the pineal region, while another was in the fourth ventricle). It is concluded that rupture of intracranial dermoid cysts is usually spontaneous and non-fatal. Persistence of fat in the subarachnoid spaces postoperatively may last asymptomatically for years. Surgery is the only way to deal with these benign lesions. If the capsule is adherent to vital areas, incomplete removal is advised as recurrence and malignant transformation are unlikely to occur.     

Congenital intracranial frontotemporal dermoid cyst presenting as a cutaneous fistula

BACKGROUND: Intracranial extension and a cutaneous sinus tract are rarely seen with craniofacial dermoid cysts, with few cases reported in the literature. METHODS: We report a case of a 1-year-old girl who was initially seen with a cutaneous fistula of the frontotemporal region, which revealed an intracranial dermoid cyst. RESULTS: The patient underwent a right lateral orbitotomy by a bicoronal approach. The cyst was seated within the lateral orbital wall, with intracranial extension through the temporal and sphenoidal bones to the dura of the temporal lobe. Histopathologic analysis confirmed the diagnosis of a dermoid cyst. CONCLUSIONS: Craniofacial dermoid cysts may be associated with a cutaneous sinus tract and/or intracranial extension. Failure to recognize and promptly treat these lesions may lead to a progressive skeletal distortion and/or recurrent infection with a potential for meningitis or cerebral abscess. Therefore, detailed CT and MRI scans are mandatory before surgical treatment of any cutaneous fistula in the head and neck region.     

Intra-axial CNS dermoid cyst

Intracranial dermoid cysts are rare tumors. They constitute 0.3% of intracranial tumors. These are commonly seen in the midline and sylvian area. Intraaxial lesions are extremely rare. We report the case of a 35-years-old female with a large intraaxial dermoid cyst, which was reported as oligodendroglioma on imaging studies done preoperatively, but was confirmed to be a dermoid cyst intra-operatively and on histopathological examination; thus highlighting a diagnostic dilemma. Patient did well post operatively and there is no recurrence in the one year follow-up. To conclude, dermoid cysts are rare benign tumors, and intraaxial lesions are still rarer. Complete surgical excision may become difficult due to adherence to nerves and vessels.     

Preoperative diagnosis of a ruptured intracranial dermoid cyst by computerized tomography. Case report

A case of ruptured intracranaial dermoid cyst in the right middle fossa is reported. A definitive diagnosis of the lesion and the fact that it had ruptured was made possible by specific computerized tomographic findings. The findings were confirmed at surgery.     

Case of presacral dermoid cyst

A case report of a presacral dermoid cyst in an adult. A 39-year-old man visited our hospital because of lower abdominal pain. A soft mass was palpable on the right side wall of rectum. Computed tomographic (CT) scan, transrectal ultrasonography and MR imaging showed presacral cystic tumor with a diameter of 10 cm. The tumor was resected by using a sacral approach. It contained muddy substance and hairs. Histopathological examination showed that the tumor wall was made of stratified squamous epithelium with skin appendage. Hence, it was diagnosed as a dermoid cyst. After operation, wound infection and dehiscence occurred, but it healed after conservative treatment. Complete excision of developmental cysts is advised because of possibility of malignancy and infection.     

Giant dermoid cyst of sternum

Dermoid cysts are lesions located in the subcutaneous tissue, containing epidermis and epidermal appendages and being common found in the head and neck. However, such lesion can be found in other parts of the body. The present case, shows an atypical presentation of a giant dermoid cyst on the sternum of a child. Although atypical, the dermoid cyst must be considered in the diagnosis of sternal masses.     

Nasal dermoid with intracranial involvement

Nasal dermoids are unusual lesions resulting from embryopathology. They are diagnosed easily by physical examination. Treatment is complete surgical excision, aided by microsurgical techniques. Involvement of the skullbase is common with "deep-seated" ND, and intracranial involvement is not uncommon. The high-resolution CT scanner is believed to be valuable in diagnosing deep involvement, including intracranial extension. The finding of a bifid crista galli is suggestive of intracranial involvement. Neurosurgical consultation is mandatory for all cases of ND when deep extension is suspected.     

A case of recurrent-rupture dermoid cyst

A 58-year-old man was seen because of general convulsions. The neurological findings were normal at his first visit, but CT revealed a low density mass in the right hypothalamus with calcification. T1-weighted image revealed multiple high intensity lesions in the subarachnoid space. Only anti-epileptic drugs were prescribed. He was readmitted one year later because of a traffic accident due to convulsions. CT and MRI revealed other new lesions in the bilateral anterior horn. After four uneventful years, follow-up CT revealed a dilation of the third ventricle. MRI using the fat suppression method showed enhancement around the main tumor and the wall of the lateral ventricles and stenosis of the aqueduct. Right frontotemporal craniotomy was performed. Thickening of the arachnoids and floating lipid droplets were seen in the sub-arachnoid space. A yellowish tumor was found in the suprasellar region, adhering to the internal carotid artery. The tumor contained soft yellowish tissue and hair. Only partial removal was carried out because of severe adhesion to perforators. The lamina terminalis was opened after tumor removal. The postoperative course was uneventful except for transient diabetes insipidus.     

Mediastinal dermoid cyst with bronchial fistula

Mediastinal dermoids are very rare and rarely do they rupture into an adjacent structure. They may attain huge size but are potentially curable with surgical resection. We report a 25-year-old male with occasional hemoptysis and Trichoptysis (expectoration of hair). He underwent successful surgical resection with complete recovery.