A 4-day-old baby was admitted with a large posterior fontanelle encephalocele. The baby was the third child of a consanguineous marriage. Two older siblings, 5 and 3 years old, were normal. The baby had a small head with a circumference of 30 cm only and an encephalocele with a circumference of 37 cm. The baby was active and there was no other neural tube defect or any other congenital anomalies. Noncontrast CT scan of the head with bone window showed a large posteriorly located encephalocele above the occipital bone, containing a small amount of brain tissue and a large volume of CSF. The baby was operated on in the lateral position and the encephalocele was excised. The dural defect was closed directly. The baby had an uneventful postoperative recovery. Twenty months later, the baby was well with no gross neurological deficits

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Shunt migration into the cranial ventricle is a rare complication of shunt surgery. We encountered this complication in an infant within three weeks of insertion. The shunt tube was removed and replaced by another tube with a reservoir, following which the child did well.

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Primary benign cystic lesions in the brain are uncommon. However, extracerebral cysts like arachnoid cyst, epidermoid cyst and craniopharyngiomas are fairly common lesions. Also, colloid cyst in the third ventricle, dermoid cyst and endodermal cyst in the extracerebral location are not uncommon. On the contrary, intraventricular ependymal and choroidal cysts in the intraventricular location are infrequent. Surgical intervention is warranted in cysts, which produce a mass effect and raised intracranial pressure. We present an interesting case of a giant intraventricular ependymal cyst in the temporal horn in a 14-year-old boy, who presented with recent onset of headaches and epilepsy. He also had long-standing progressive proptosis of the left eye and left temporal bossing. Excision of this cystic lesion was curative. Interesting clinical and neuroimaging features are presented.

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