Case report. Transient cerebral ischemia as a manifestation of ruptured intracranial dermoid cyst

Microscopic and neuroendoscopic treatment of a large ruptured supratentorial dermoid cyst with extensive dissemination: a case report and literature review

Introduction and importance

Intracranial dermoid cysts are rare, constituting 0.04% to 0.6% of all intracranial tumors. They often arise from ectodermal cells trapped during neural tube formation. We report a case of spontaneous rupture of a large tentorial epithelioid cyst, which caused massive dissemination of liquid cholesterol into the subarachnoid cisterns and ventricles.

Presentation of case

A 28-year-old male presented with a two-week history of headache and memory decline. CT and MRI revealed a 9x6 cm lesion in the left frontotemporal region with widespread dissemination of lipid droplets. Surgical resection was performed using a microscope combined with a neuroendoscope. Pathology confirmed a dermoid cyst.

Clinical discussion

Ruptured dermoid cysts can cause significant symptoms due to the dissemination of cyst contents. Imaging is crucial for diagnosis and surgical planning. The combined microscopic and neuroendoscopic approach minimized blind spots and allowed thorough tumor exposure, facilitating complete resection with minimal residual complications. Postoperative outcomes were favorable, with imaging confirming substantial tumor removal and restored cerebrospinal fluid circulation.

Conclusion

Prompt diagnosis and comprehensive surgical intervention are essential for managing ruptured intracranial dermoid cysts. Combined microscopic and neuroendoscopic techniques are effective in achieving extensive resection and reducing complications.

Postoperative Symptomatic Cerebral Vasospasm: Requiring Attention Following an Uneventful Resection of an Epidermoid Cyst - A Case Report and Literature Review

Cerebral vasospasm associated with epidermoid cyst can be caused by tumor content spillage, such as spontaneous rupture and postsurgical resection. Symptomatic cerebral vasospasm following the resection of an intracranial epidermoid cyst is a rare but serious complication that lacks a consensus on treatment. Case presentation: A 10-year-old girl underwent an uneventful complete resection of a left cerebellopontine angle epidermoid cyst. On the second postoperative day (POD 2), she exhibited reduced speech, confusion, and hyperventilation followed by hypocapnia. On POD 4, she developed right hemiparesis and dysphasia. Cerebral magnetic resonance imaging showed restricted diffusion areas in her left temporal and parietal lobes and the dorsal thalamus. Magnetic resonance angiograms confirmed narrowing of the proximal middle cerebral arteries, consistent with vasospasm. Conservative management, consisting of intravenous hydration and corticosteroid administration, proved effective in resolving her symptoms and radiologic vasospasm. On POD 8, the extensive restricted diffusion areas notably decreased in size. Her right hemiparesis was completely resolved, and her dysphasia gradually improved over time. At the 1-year follow-up, she exhibited moderate transcortical sensory dysphasia. To our knowledge, this study is the first to report on a pediatric case of symptomatic cerebral vasospasm following an epidermoid cyst resection. The combination of tumor content spillage and hyperventilation may contribute to the occurrence of cerebral vasospasm and subsequent ischemia. This complication should be acknowledged after a complete and uneventful resection.

Asymptomatic rupture of an intracranial dermoid cyst: to intervene or not to intervene?

Dermoid cysts are an exceedingly rare phenomenon inside the cranial vault. These benign, slow-growing lesions can rupture, releasing cyst contents into the ventricular system and subarachnoid space causing pathology in the form of chemical meningitis and vasospasm. Here, we present the case of a 26-year-old man who was investigated for a facial nerve palsy and was incidentally found to have a ruptured dermoid cyst in the pineal region, with dissemination of cyst contents throughout the ventricular system.

Symptomatic Cerebral Vasospasm After Transsphenoidal Tumor Resection: Two Case Reports and Systematic Literature Review

Cerebral vasospasm is a rare life-threatening complication of transsphenoidal surgery (TSS). We report our experience with two cases of symptomatic vasospasm after endoscopic TSS, alongside a systematic review of published cases. Two patients who underwent endoscopic TSS for resection of a tuberculum sella meningioma (case 1) and pituitary adenoma (case 2) developed symptomatic vasospasm. Clinical variables, including demographics, histopathology, the extent of subarachnoid hemorrhage (SAH), diabetes insipidus (DI), day of vasospasm, vasospasm symptoms, vessels involved, management, and clinical outcome, were retrospectively extracted. We subsequently reviewed published cases of symptomatic post-TSS vasospasm. Including our two cases, we identified 34 reported cases of TSS complicated by symptomatic vasospasm. Female patients accounted for 20 (58.8%) of 34 cases. The average age was 48.1 ± 12.9 years. The majority of patients exhibited postoperative SAH (70.6%). The average delay to vasospasm presentation was 8.5 ± 3.6 days. The majority of patients exhibited vasospasm in multiple vessels, typically involving the anterior circulation. Hemodynamic augmentation with hemodilution, hypertension, and hypervolemia was the most common treatment. Death occurred in six (17.6%) of 34 patients. Common deficits included residual extremity weakness (17.6%), pituitary insufficiency (8.8%), and cognitive deficits (8.8%). Symptomatic vasospasm is a rare, potentially fatal complication of TSS. The most consistent risk factor is SAH. Early diagnosis requires a high index of suspicion when confronted with intractable DI, acute mental status change, or focal deficits in the days after TSS. Morbidity and death are significant risks in patients with this complication.

Focal traumatic rupture of a dermoid cyst in a pediatric patient: case report and literature review

BACKGROUND

Dermoid cysts are rare congenital teratomas that can occasionally rupture and cause chemical meningitis, neurological deficit, or hydrocephalus. Rarely, dermoid cysts in the pediatric population can rupture spontaneously and even more rarely rupture due to trauma. To date, there are only five documented cases of traumatic rupture of a dermoid cyst. A 2-year-old male presented with 5 days of left eye ptosis and ophthalmoplegia after suffering a fall and was found to have a ruptured left anterior clinoid dermoid cyst that was surgically resected. The patient had significant improvement postoperatively.

SIGNIFICANCE

To the authors' knowledge, this is the first reported case in the literature of a ruptured dermoid cyst after trauma in a pediatric patient and the first case of a traumatically ruptured dermoid cyst presenting with neurological deficit.

[Dermoid cysts of the posterior cerebral fossa in children revealed by recurrent aseptic meningitis: Report of two cases and a review of the literature]

INTRODUCTION

Dermoid cysts of central nervous system are very rare. The usual clinical presentation is dominated by intracranial hypertension, epilepsy and cranial palsy. The revelation mode could be recurrent aseptic meningitis.

AIM

The aim of this case report is to consider the dermoid cyst as regards the differential diagnosis in children treated for recurrent aseptic meningitis to avoid misdiagnosis and ice qui a orienté le diagnostic à une méningitnadequate treatment.

METHODS

Two children were admitted in the pediatric department for recurrent aseptic meningitis. The MRI confirmed the presence of a posterior fossa dermoid cyst.

RESULTS

Loss of meningitis after microsurgical resection.

CONCLUSION

The diagnosis of dermoid cyst is performed and reconsidered at an early stage in aseptic meningitis in order to establish an adequate therapy, which is surgery.

Dermoid Cyst of the Prepontine Cistern and Meckel's Cave: Illustrative Case and Systematic Review

Objective  Dermoid cysts are benign, congenital malformations that account for ∼0.5% of intracranial neoplasms. The authors describe a 42-year-old female with a prepontine dermoid cyst who underwent apparent gross total resection (GTR) but experienced cyst recurrence. To date, very few cases of prepontine dermoid cysts have been reported. The prevalent region where these cysts are located can be difficult to determine. In addition, the authors systematically review the literature to characterize the clinical presentation, anatomical distribution, and surgical outcomes of intracranial dermoid cysts. Design  Systematic review. Setting/Participants  PubMed, Web of Science, and Scopus databases. Main Outcome Measures  Extent of resection, symptom improvement, and recurrence rates. Results  A total of 69 patients with intracranial dermoid cysts were identified. Three (4.3%) intracranial dermoid cysts were located in the prepontine cistern. The average age of patients was 33.3 years. The most common presenting symptoms were headache (52.2%) and visual disturbances (33.3%). Intracranial dermoid cysts were distributed similarly throughout the anterior, middle, and posterior cranial fossae (29.0%, 36.2%, and 29.0%, respectively). GTR was achieved in 42.0% of cases. Thirty-four (49.3%) patients experienced symptom resolution. Recurrence rate was 5.8% at a mean follow-up of 2.1 years. Conclusions  Intracranial dermoid cysts most often present as headaches and visual disturbances. Intracranial dermoid cysts were found in the anterior, middle, and posterior cranial fossae at similar frequencies but with clear predilections for the Sylvian fissure, sellar region, and cerebellar vermis. Outcomes following surgical excision of intracranial dermoid cysts are generally favorable despite moderate rates of GTR.

Insular and Sylvian Fissure Dermoid Cyst with Giant Cell Reactivity: Case Report and Review of Literature

BACKGROUND

Dermoid cysts are rare intracranial tumors that are most commonly found infratentorially and along the midline. Characterized by slow growth and often found incidentally, these lesions can nonetheless have severe complications, notably rupture leading to chemical meningitis. They infrequently present as a supratentorial and lateralized mass. As such, sylvian fissure dermoid cysts are exquisitely rare. We present a rare case of a dermoid cyst with giant cell reactivity suggestive of focal rupture and chronic inflammation.

CASE DESCRIPTION

A 61-year-old female presented with new-onset seizures. Magnetic resonance imaging revealed a right insular mass measuring 4.3 × 4.5 cm with compression of the ipsilateral frontal and temporal lobes. The mass was nonenhancing; however, it was bright on diffusion-weighted imaging, suggesting a dermoid cyst. She underwent craniotomy for tumor resection. Histologic analysis revealed keratinizing squamous epithelium, sebaceous glands, and hair follicles associated with giant cell reaction involving the capsule of the cyst consisted with dermoid cyst. At 2.5 years post operation, she is seizure free and without evidence of recurrence.

CONCLUSION

The dermoid cyst in our patient was not grossly ruptured, but histopathologic analysis revealed giant cell reactivity, which may indicate focal rupture or chronic inflammation. The relationship between rupture of dermoid cysts and inflammation is not well elucidated. It is not known whether symptoms occur immediately after rupture or as an acute manifestation of a chronic process following rupture. As these lesions are quite rare and rupture is even rarer, more diligence on our part regarding details of histopathology for dermoid cysts is necessary.

Progressive visual loss following rupture of an intracranial dermoid cyst

A 51-year-old man with several months of headache and progressive visual decline was found to have bilateral optic disc pallor with significant impairment of visual acuity. Despite a thorough ophthalmologic evaluation, the cause of visual loss could not be elucidated. MRI of the brain revealed a lesion in the left anterior Sylvian fissure as well as disseminated foci of subarachnoid fat consistent with a diagnosis of a ruptured dermoid cyst. The decision for open surgical resection was chosen to minimize the risk of cyst re-rupture and further visual or neurologic decline. The diagnosis of dermoid cyst was confirmed at the time of surgery. Vasospasm-induced ischemia of the optic nerves, optic chiasm or bilateral optic tracts secondary to the inflammatory reaction following cyst rupture is the most likely mechanism of visual loss in this patient. To the authors' knowledge, this report represents the first reported case of visual loss secondary to rupture of an intracranial dermoid cyst not related to mass effect of the tumor on the optic apparatus, visual pathways or visual cortex.

Ruptured intracranial dermoid cyst associated with rupture of cerebral aneurysm

Many tumors have been reported to coexist with cerebral aneurysm. However, intracranial dermoid cysts associated with cerebral aneurysm are very rare. We report a case in which rupture of a cerebral aneurysm resulted in a ruptured dermoid cyst. We present this interesting case and review current literature about the relationship between tumors and aneurysm formation.

Intracranial vasospasm with delayed ischaemic deficit following epidermoid cyst resection

Intracranial vasospasm following surgical removal of intracranial tumours is rare. To our knowledge there have been no previously reported cases of delayed vasospasm occurring post debulking of epidermoid cysts. We report a case in which vasospasm led to established cerebral infarction 2 weeks postoperatively. MRI and serial magnetic resonance angiography (MRA) reliably show initial multiple stenoses in the vertebral and internal carotid arteries followed by their spontaneous normalisation. MRA imaging is now of sufficient quality to enable it to be a safe and effective means of both looking for vasospasm and monitoring its resolution.

Ruptured intracranial dermoid cyst with infarction in the basal ganglia--case report

A 32-year-old, right-handed man presented with chronic headache persisting for the past 5 years. On admission, neurological examination revealed mild papilledema and bitemporal defects of the visual fields. Computed tomography showed a hypodense lesion in the suprasellar region. Magnetic resonance imaging revealed a 2.2 x 2.4 x 2.5-cm heterogeneously hyperintense lesion in the suprasellar region and an infarct region in the right basal ganglia on the T(1)- and T(2)-weighted images. The lesion was subtotally removed because part of the capsule was tightly adherent to important surrounding neurovascular structures. Histological analysis confirmed the diagnosis of dermoid cyst. Ruptured intracranial dermoid cyst may manifest as infarction in the basal ganglia caused by localized arterial inflammatory reaction combined with compression of the right internal carotid artery.

Intracranial dermoid cysts: variations of radiological and clinical features

BACKGROUND

Intracranial dermoid cysts are uncommon, and their clinical features as well as surgical management differ from patient to patient. Dermoids are generally benign lesions, but may cause spontaneous complications such as meningitis and/or hydrocephalus due to rupture and epileptic seizures depending on their location. Little has been reported about characteristic imaging findings with resulting therapeutic considerations, and only a few reports exist about associated hydrocephalus. Imaging modalities have changed and can facilitate differential diagnosis and follow-up if applied correctly. In this paper, we attempt to contribute our clinical experience with the management of dermoid cysts.

PATIENTS AND METHODS

The charts of five men and two women with intracranial dermoid cysts were retrospectively reviewed. The patients were treated between September 1993 and September 2006. Selected patients are presented in detail.

RESULTS

Tumour location, size and radiographic characteristics varied in each patient. Clinical presentations comprised focal neurological deficits as well as epileptic seizures, persistent headache, mental changes and psycho-organic syndromes. One patient underwent delayed ventriculo-peritoneal shunting after ruptured fatty particles caused obstructive hydrocephalus. Despite dermoid rupture into the subarachnoid space, three patients never developed hydrocephalus. Diffuse vascular supra-tentorial lesions were seen in one patient as a result of aseptic meningitis. Diffusion-weighted imaging (DWI) hyperintensity in dermoids is related to decrease of water proton diffusion and should be used for both the diagnosis and follow-up of this lesion.

CONCLUSION

Although dermoid cysts are known to be benign entities per se, their rupture can cause a wide range of symptoms including aseptic meningitis and/or hydrocephalus. This may be due to intraventricular obstruction and/or paraventricular compression. While rupture does not necessarily bring about hydrocephalus, radical removal of the tumour and close monitoring of ventricular size is required. Although not widely recognised as such, DWI is considered to be a useful imaging modality in the diagnosis and follow-up of dermoids.

Neuropsychological profiling of ischemic deficit secondary to ruptured dermoid cyst: a case report

This report presents a case of a 39-year-old male with a spontaneously ruptured frontotemporal dermoid cyst. Intraoperatively, during surgical resection of the cyst, significant fat spillage occurred associated with a profound anterior circulation vasospasm. The patient underwent serial neuropsychological evaluation over five months, revealing a profile of initial deterioration, followed by delayed recovery of cognitive function. A review of the literature reveals three other case reports describing ischemic deficit after dermoid rupture, but the cognitive impairment associated with this pathology has never been formally profiled before, and it may be possible to draw analogies to the well-established ischemic deficit post-subarachnoid hemorrhage found in the literature. Neuropsychological profiling additionally informs us about the nature and progression of this entity from a cognitive perspective and whether the etiology of deficit caused by dermoid rupture could be localized, or global, secondary to diffuse fatty dissemination in the CSF.

Ruptured intracranial dermoid cysts

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.

Sylvian fissure dermoid cyst with intratumoral hemorrhage: case report

It is rare for a dermoid cyst to develop intratumoral hemorrhage. A 61-year-old woman had a sudden-onset left hemiparesis and slow response to verbal requests for one week when unenhanced computed tomography scanning revealed a mixed iso- and hypo-dense heterogeneous lesion in the right fronto-temporal area. T1-weighted magnetic resonance imaging (MRI) of the brain showed a mixed hyper- and hypo-intense tumor in the right fronto-temporal area. The tumor became hyperintense on T2-weighted MRI and was faintly enhanced at tumor periphery on T1-weighted MRI. The tumor was excised and pathological examination revealed a dermoid cyst with intratumoral hemorrhage. The post-operative course was complicated by hemorrhage in the tumor bed, which was evacuated immediately. The patient improved and could walk without support two weeks after the second operation. After 1 year of follow-up, she was well and without neurological deficits. To the best of our knowledge after a literature review, only two previous cases of dermoid cyst have featured intratumoral hemorrhage.

Bilateral Reversible Deafness after Surgery for Unilateral Epidermoid Tumor: An Unusual Complication: Case Report

OBJECTIVE AND IMPORTANCE:

We present an unusual complication of bilateral hearing loss after surgery for unilateral epidermoid tumor situated at the right pontocerebellar junction. The neurosurgeon must know the possible causes of this catastrophic complication and should take every possible measure to avoid it.

CLINICAL PRESENTATION:

A 43-year-old male patient presented with progressive hearing loss in the right ear. A radiological examination demonstrated a mass lesion at the right pontocerebellar junction. A pure tone audiogram revealed sensorineural hearing impairment of the right ear. A brainstem auditory evoked potential test confirmed this with reduced amplitudes and a prolonged I–V interval.

INTERVENTION:

The patient was operated on via a right paramedian suboccipital craniectomy. The tumor was completely excised, and all of the cranial nerves were preserved during the operation. Postoperatively, the patient developed total bilateral hearing loss, which improved significantly over time.

CONCLUSION:

Controlled cerebrospinal fluid drainage during exposure and tumor excision may reduce the possibility of shift and traction on the neural structures and help to prevent ischemic injury. Frequent irrigation of the surgical field and minimizing the spilling of the tumor contents may reduce the risk of chemical irritation. The use of corticosteroids may also help during the postoperative period.

Delayed ischemic deficit after resection of a large intracranial dermoid: case report and review of the literature

OBJECTIVE AND IMPORTANCE

A unique case of delayed ischemic deficit after resection of a large intracranial dermoid is presented.

CLINICAL PRESENTATION

A 23-year-old woman, 36 hours after the uneventful gross total resection of a large intracranial dermoid cyst, slowly developed a progressive mixed aphasia and right hemiparesis. Magnetic resonance imaging and magnetic resonance angiography revealed small infarcts of the left putamen and temporal-occipital junction and a vasospastic tapering of the left M1 segment.

INTERVENTION

Angiography confirmed severe vasospastic tapering of the left M1 and M2 segments. Endovascular treatment successfully restored flow in the left superior division. However, the initial attempt at low-pressure dilation of the inferior division led to vessel rupture. Seven months after reoperation for emergent trapping of the M1 segment, the patient made an excellent recovery, with only mild right-hand incoordination.

CONCLUSION

Ruptured dermoid cysts are a risk for early and delayed cerebral ischemia, and endovascular treatment of dermoid-encased vessels may carry a higher risk for rupture.

Expanding experience with spontaneous dermoid rupture in the MRI era: diagnosis and follow-up

With widespread use of CT and MR imaging, experience with spontaneous dermoid rupture has significantly increased. What was previously believed to be a generally severe or even fatal accident, being the diagnosis made either at surgery or autopsy, or in patients with such consequent conditions as chemical meningitis or obstructive hydrocephalus, now appears to be more frequent than previously thought, and there is some evidence that it may also cause only a slight symptomatology or even be quite asymptomatic. We reviewed the clinical and imaging data of our series of five patients with spontaneously ruptured dermoids, spinal in one case, and intracranial supratentorial in four. These had their diagnosis following mild symptoms (number two cases) or incidentally (number two cases); the spinal tumor caused acute bladder dysfunction, possibly while undergoing rupture, and was associated with indolent intracranial fat spread. Three of the patients also had MR demonstration of asymptomatic persistence of fat spread in the subarachnoid spaces, respectively, 3, 4, and 5 years after rupture. One of the five cases, concerning a parasellar dermoid followed up over 6 years, provides the first demonstration of MR signal intensity change of the tumor prior to rupture.

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).

Intra-axial dermoid/epidermoid tumors of the brainstem in children

BACKGROUND

Epidermoid and dermoid cysts are rare intracranial space-occupying lesions, which account for about 1% of all intracranial tumors; they are even rarer in the pediatric age group. Among the various locations, that inside the brain stem is quite exceptional (only 12 cases reported to date in the literature). We report two additional cases occurring in children, underlining their clinical characteristics, the difficulties faced in the diagnostic work-up, and the surgical treatment adopted (which consisted of removal of the cyst contents and partial resection of the cyst membrane, because of its adherence to the surrounding nervous and vascular structures).

METHODS

We report two cases of intraaxial dermoid/epidermoid cysts observed within the last 5 years. Both patients complained of cervico-nuchal pain, with a remittent/intermittent character in one of them; this patient also exhibited transient 6th and 7th cranial nerve deficit. One lesion was approached through the floor of the fourth ventricle, the second one through the ventrolateral aspect of the brainstem.

RESULTS

Subtotal tumor resection was achieved in both cases. Both patients had a smooth postoperative course without permanent neurological deficits. In the first patient residual tumor remains stable on follow-up MRI. In the second one, early tumor regrowth necessitated a second operation, after which the residual tumor has remained stable.

CONCLUSIONS

Based on our experience we suggest that a cautious surgical approach ("conservative" resection) to these lesions is the best choice. In fact, attempts at radical removal carry unacceptably high morbidity and mortality rates.

Stroke related to a dermoid cyst: case report

OBJECTIVE AND IMPORTANCE

We report the case of a woman presenting with sudden neurological deficit, revealing a parasellar dermoid cyst. To our knowledge, this clinicopathological finding is the first reported in the literature.

CLINICAL PRESENTATION

A neurological examination of the patient revealed a left hemiparesis, including central facial palsy, which hampered her speech. The well-documented neuroradiological work-up (including computed tomography, magnetic resonance imaging, and magnetic resonance angiography) demonstrated right frontorolandic ischemia caused by a right supra- and parasellar dermoid cyst leading to middle and anterior cerebral arterial stenoses.

INTERVENTION

Surgical intervention, using a right subfrontopterional approach, was successful. Complete dermoid cyst removal was achieved. The mechanism of the arterial stenoses is extensively discussed and is thought to result from an inflammatory reaction of the basal vessels.

CONCLUSION

The patient recovered fully. Nevertheless, postoperative magnetic resonance imaging confirmed cerebral infarction.

Spinal dermoid cysts originating intracranial fat drops causing obstructive hydrocephalus: case reports

The authors report two cases of spinal dermoid cysts whose rupture originated the migration of free fat drops into the ventricles and intracranial subarachnoid spaces. In both cases the fat drops caused obstructive hydrocephalus, which represents a quite exceptional complication. Moreover, one of the cases is unique, since the finding of intracranial fat causing hydrocephalus considerably preceded the discovery of the spinal neoplasm. The authors suggest that the finding of intracranial fat in the absence of a local source makes the search for a intraspinal dermoid or epidermoid tumor mandatory.

Vasospasm after resection of skull base tumors

Vasospasm after resection of skull base tumors is a rare complication that often produces serious ischemic sequelae. In four of the authors' recent cases, vasospasm complicated the patient's postoperative course. A review of the literature produced a number of cases that can help determine possible causes of vasospasm after tumor resection, ways to prevent it, and methods to evaluate it when it occurs. The cause appears to be multifactorial and the surgical approach may contribute to the pathogenesis of vasospasm. Physicians must have a high degree of suspicion to detect vasospasm at an early stage of skull base surgery. Cerebral blood flow measurement and transcranial Doppler are useful monitoring tools.

Ruptured suprasellar dermoid cyst presenting olfactory delusion (Eigengeruchs erlebnis)

A 24-year-old man sought treatment of a long-standing olfactory delusion (Eigengeruchs erlebnis) and associated psychotic symptoms, which disappeared after the removal of a suprasellar dermoid cyst. The pathophysiology of the phenomenon is discussed.

Ruptured dermoid tumor of the cavernous sinus associated with the syndrome of fat embolism. Case report

The syndrome of fat embolism is a well-known clinicopathological entity that may appear 2 to 4 days after skeletal trauma; nontraumatic causes have been recognized, however. This report details the fat embolism syndrome occurring in a patient after surgery within the cavernous sinus to remove a dermoid tumor.

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.

CT and MRI of ruptured intracranial dermoids

Two patients with ruptured intracranial dermoids, examined with both CT and MRI are reported. Clinical presentation was transient cerebral ischemia in one patient and acute meningeal signs in the other. CT scan showed typical fat density of the tumor and the subarachnoid space. On MRI both the tumor and the subarachnoid fat, were strongly hyperintense on T1-weighted images.

Cranial and spinal tumors with meningitic onset

We review the literature on cases of cranial or spinal tumor presenting with meningitic symptoms. Embryonal tumors-dermoid cysts, epidermoid cysts, craniopharyngiomas, teratomas-and malignant gliomas were the cause of most of the episodes of chemical meningitis, single or multiple in patients with no neurological symptoms. Differential diagnosis from aseptic meningitis, especially from Mollaret aseptic meningitis, is essential.

The diagnosis of ruptured intracranial dermoid cysts

We present a case of a spontaneous asymptomatic rupture of an intracranial dermoid cyst with CT and MR images. The literature on the subject is reviewed. The potential associated complications are discussed.