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.     

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).     

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.     

Current diagnostic criteria for intracranial epidermoid and dermoid cysts

The authors report a recent series of 12 intra-cranial epidermoid and dermoid cysts. After they had reminded the main classical radiological and clinical signs which are rarely specific, they study C.T. scan semiology which at present and in most cases permits to base an undoubted diagnosis.     

Supratentorial dermoid cysts

Supratentorial dermoid cysts are rare lesions. In eight cases presented here, the lack of recurrence after subtotal removal of the capsule and the good long-term prognosis are emphasized. This finding is in agreement with the literature. The frequent relationship of these lesions with the cavernous sinus suggests a vascular genesis in the development of intracranial dermoid cysts.     

The diagnosis and surgical treatment of intracranial arachnoid cysts

Acta Neurochirurgica - Intracranial arachnoid cysts are becoming a more frequent finding as a result of the increased use of cranial computed tomography. We present 26 patients with such lesions...     

Chemical meningitis in ruptured intracranial dermoid. Case report and review of the literature

A rare case of ruptured frontal dermoid tumor with typical magnetic resonance imaging and computed tomography appearances and presenting with chemical meningitis is reported.     

Bilateral frontozygomatic dermoid cysts

A unique case of frontozygomatic dermoids in a 4-year-old child is presented. A bilateral, synchronous presentation in this location has not been reported previously in the literature. Both lesions were excised concurrently through upper eyelid crease incisions. The etiology, natural history, management, and prognosis of dermoids are reviewed.     

The diagnosis and neuroendoscopic treatment of noncommunicating intracranial arachnoid cysts

BACKGROUND: The aim of this study was to explore the CTC classification, establish surgical indication, and evaluate neuroendoscopic treatment of IAC. METHODS: Computed tomographic cisternography was applied to screen NCIAC cases out of 22 patients with IAC. Noncommunicating intracranial arachnoid cyst cases were treated with neuroendoscopic fenestration between IAC and cerebral cistern/ventricle with rigid neuroendoscope. RESULTS: All the NCIAC patients had definite neurologic findings. Postoperatively, the clinical status and situations of all the patients were improved, and some patients were even cured. Only 1 case suffered complicated chronic subdural hematoma and was cured by burr hole drainage. Follow-up CT scan of 9 cases showed that the cysts decreased markedly in size; most of the surrounding spaces were filled by normal cerebral tissue. CONCLUSION: (1) CTC is specific for the differential diagnosis of IAC, which can be classified into CIAC and NCIAC with CTC. (2) NCIAC with definite neurologic findings have surgical indication. (3) Compared with traditional treatments, neuroendoscopic cystic fenestration is more effective and minimally invasive with less mortality and morbidity.     

Treatment of ovarian dermoid cysts

The purpose of this study was to discuss the place and the specific modalities of laparoscopic surgery in the management of ovarian dermoid cysts. This retrospective and noncomparative study was carried out in 65 patients who presented dermoid ovarian cyst between January 1986 and December 1990 in our institution. The surgical treatment was performed purely by laparoscopy in 86.2% of the cases (56 patients). The modalities of laparoscopic surgery were as follows: ovariectomy (8 cases; 14.3%), transparietal cystectomy (4 cases; 7.1%) and intraperitoneal cystectomy (44 cases; 78.6%). In 15 cases (15/44=34%) the intraperitoneal cystectomy was carried out without opening the cyst and the intact cyst was extracted using an endoscopic impermeable sack. We observed no cases of chemical peritonitis. The risk of recurrence after conservative treatment is 4% (two patients) and out of the ten patients for whom a second-look laparoscopy was performed only two (20%) presented adhesions. Laparoscopic treatment of dermoid ovarian cysts is feasible, safe, and effective. The treatment can be conservative in over 80% of the cases. The specific risk of chemical peritonitis can be countered by a change in the cystectomy technique. The use of an impermeable laparoscopic sack permits extraction of the cyst without any peritoneal contamination.     

Ruptured intracranial dermoid cyst

Intradural dermoids are rare congenital tumors representing approximately 0.05% of all intracranial lesions. These benign tumors have a typical appearance on CT and MR due to their lipid components. The complication caused by rupture are the spillage of the fatty material into the cerebrospinal fluid. We report a case of a ruptured dermoid cyst showing fat/fluid levels in both side ventricles and fatty material in the subarachnoid space on CT and MR-imaging and the follow-up over four years after incomplete resection of the tumor.     

Intraspinal epidermoid and dermoid cysts

Summary Seven cases of intraspinal inclusion cysts, surgically treated between 1970 and 1984, are reported in this paper. Four were epidermoid cysts and three dermoid. Two cysts were located in the thoracic spine (one dermoid and one epidermoid) and five in the lumbosacral region (three epidermoid and two dermoid). Associated spinal dysraphia was noted in five cases. Congenital dermal sinus was found in two cases, spina bifida cystica in one, spina bifida occulta in one, and diastematomyelia in one case. The average postoperative follow-up period was 5 years. No neurological symptoms were found in the five patients who received early surgical treatment, but for the two patients whose operations were late, there were some residual neurological deficits. Therefore, early and accurate diagnosis and radical surgical extirpation are emphasized.

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Zusammenfassung In diesem Bericht wird eine Serie von sieben Fallen eingeschlossener Cysten in der Wirbelsaule beschrieben, die zwischen 1970 und 1984 behandelt wurden. Vier dieser Cysten waren epidermoid, drei dermoid. Zwei befanden sich im Brustwirbelbereich (eine Epidermoidcyste and eine Dermoid cyste) und fünf in der lumbosakralen Region (drei Epidermoid- und zwei Dermoidcysten). In fünf Fällen wurden hiermit verbundene Disraphismen in der Wirbelsäule festgestellt, ein angeborener Dermalsinus in zwei Fällen, spina bifida cystica, spina bifida occulta und diastematomyelia jeweils in den drei übrigen. Im Durchschnitt betrug die postoperative Nachbehandlung 5 Jahre. Die Rolle der frühen und

     

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.