Ruptured Suprasellar Dermoid Cyst Treated With Lumbar Drain to Prevent Postoperative Hydrocephalus: Case Report and Focused Review of Literature

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.

Intrasellar Dermoid Cyst: Case Report of a Rare Lesion and Systematic Literature Review Comparing Intrasellar, Suprasellar, and Parasellar Locations

OBJECTIVE

Intracranial dermoid cyst (DC) is a rare benign, slow-growing lesion, most commonly arising along the midline. They can occur in the supratentorial compartment, very rarely involve the sellar region and only exceptionally are intrasellar. The aim of our study is to address the challenges in the diagnosis and management of sellar DCs.

METHODS

We performed a systematic review of sellar DCs, in keeping with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and described an intrasellar DC in a 32-year-old female who presented with bilateral blurring vision.

RESULTS

The review identified 4 intrasellar, 29 suprasellar, and 28 parasellar cases. Intrasellar DCs more likely present with progressive visual impairment and pituitary hormone dysfunctions during the fifth decade of life. Suprasellar and parasellar DCs are typically diagnosed during the third decade of life because of diplopia, ptosis, trigeminal hypoaesthesia/para-esthesia or cyst's rupture. Sellar DCs are typically hypodense on computed tomography scans and contain calcifications. Magnetic resonance imaging features include T1 hyperintensity, T2 heterogeneous intensity, no restriction on diffusion-weighted images, and no contrast enhancement. Surgery is the treatment of choice. Gross total resection is achieved in 60% of intrasellar and 61.9% of suprasellar and parasellar DCs. Early postoperative complications are reported in 40.0%, 16.7%, and 23.8% of intrasellar, suprasellar, and parasellar DCs, respectively.

CONCLUSIONS

Intrasellar DCs are rare lesions typically diagnosed later than suprasellar and parasellar DCs due to their different clinical presentations. However, they should be considered in the differential diagnosis of cystic lesions of the sella, including epidermoid cysts, craniopharyngiomas, Rathke's cleft cysts, and teratomas.

Late-onset rupture of an intracranial dermoid cyst: a case report

BACKGROUND

Dermoid cysts are developmental abnormalities occurring between the third and fifth week of embryogenesis. These lesions can initially develop as intracranial or extracranial and persist throughout the patient's lifetime. While generally benign, their symptoms can be due to mass effect or local irritation secondary to rupture and release of contents, typically presenting as headaches and seizures. Intracranial dermoid cysts are rare and comprise less than 1% of all intracranial lesions, with rupture occurring approximately 0.18% of the time.

CASE PRESENTATION

Our case describes a 42-year-old Hispanic female with a late-onset rupture of an intracranial dermoid cyst with associated new onset seizures. She underwent uncomplicated neurosurgical resection with mesh placement and was scheduled to follow-up as an outpatient.

CONCLUSION

To avoid rupture and associated sequelae in future patients, we recommend considering a more invasive approach as the initial strategy if internal cysts are relatively accessible.

Protracted course of chemical meningitis following posterior fossa epidermoid cyst excision – A case report

Background:

Chemical meningitis, a subtype of aseptic meningitis, as a complication of posterior fossa surgery is not a rare complication. However, the description of a severe protracted course following the surgical resection of an epidermoid cyst has not been described in the current literature. Chemical meningitis is thought to be associated with a hyperreactive inflammatory response, mediated in part by interleukin (IL)-10, IL-1β, and tumor necrosis factor-α, to the postoperative keratin debris from the spontaneous leakage or surgical release of epidermoid contents into subarachnoid spaces, which ultimately can result in patient symptoms of meningitis and hydrocephalus. Often, this remains mild and the recommended management includes a short course administration of corticosteroids.

Case Description:

The authors report such a case in a patient who underwent a redoresection for a fourth ventricular epidermoid cyst. Postoperatively, the patient returned several times with symptoms of meningitis and hydrocephalus requiring multiple hospitalizations in the ensuing months. The patient required emergent cerebrospinal fluid diversion, further posterior fossa exploration and an extended high-dose corticosteroid treatment regimen.

Conclusion:

The authors summarize the current understanding of the biochemical processes involved for the rare presentation of postoperative chemical meningitis.