Dermoid lesion of the cavernous sinus: case report and review of the literature

Abstract

Intracranial dermoids are rare congenital tumors. Supratentorial dermoid cysts were more frequently reported in the last decade, and they are known to have a predilection for the cavernous sinus. Interdurally localized dermoids presenting with ophthalmoplegia is uncommon. Previously, the association of dermoid lesions with the cavernous sinus and the complexity of the operative procedure were emphasized only by a few authors. We report a case of a dermoid cyst that was embedded fully in the cavernous sinus and review the related cavernous dermoid lesions in the literature. Fronto-orbitozygomatic craniotomy was performed, and despite adherence of the tough capsule to the cranial nerves, the lesion was grossly removed in total. The patient was doing well 1 year after the operation, and there was no recurrence of signs and symptoms. Interdural growth of cavernous dermoid tumors must be considered, and careful evaluation of preoperative computed tomography and magnetic resonance images aids in making the decision concerning the operative approach. Upon review of the literature, we detected only eight similar cases concerning cavernous dermoid cysts. Although total excision of these cavernous lesions has been reported previously, we believe that total excision can sometimes be hazardous and not feasible.

Intracranial dermoid cysts: variations of radiological and clinical features

“…Various clinical aspects such as presentation with epileptic seizures, meningitis, focal neurological deficits, hydrocephalus, sudden death and incidental diagnosis have been reported. These acute symptoms associated with the presence of dermoids, their localisation and their rupture are well documented [1,2,5,14,15,17,18,20,23,26,33,[40][41][42]. Diagnostic findings were evaluated in the past but Gd Gadolineum, N/a not available, HCP hydrocephalus, n/v nausea/vomiting, DWI diffusion weighted imaging show strong individual variation [4,8,9,13,22,24,27,31,32,36,38,44,45].…”

Interdural giant dermoid cyst of the petrous apex

“…6,16,34 Less commonly, some authors describe these tumours to be interdural. 4,[35][36][37][38] The interdural location of parasellar ECs is widely accepted in the international literature, because these lesions are believed to originate between the two layers of lateral wall of the CS or between the two dural layers of Meckel's cave. 13,14,39 In 1992, El-Kalliny reported a series of CS lateral wall tumours, describing the surgical anatomy of this region.…”

“…2,3 Those located at the petrous apex (PA) are rare and only a few reports have been published in the English literature. At the PA, DCs are generally in the intradural compartment, arising from the PA and less frequently from the middle cranial fossa (MCF) floor; however, they may also arise from the lateral wall of the cavernous sinus (CS) 4 and present interdurally. In 2007, Ammirati et al reported the first patient with a totally extradural DC of the PA, associated with extensive erosion of the petrous bone and the MCF floor.…”

Extradural Dermoid Cyst of the Parasellar Region: A Case Report

“…Intracranial dermoid cysts are rare tumors constituting less than 1% of all intracranial tumors. 1 The tumors typically arise in infants to young adults because of their congenital origin [2][3][4] and are relatively rare in middle-aged or older people. 5 They are considered to be the product of a defective closure of the neural tube, which occurs between the third and fifth gestational week.…”

“…4 Other common symptoms including headaches, seizures, and chemical meningitis, and visual disturbances occur late in the clinical course because of its slowgrowing nature. 2,3,6 Many reports have mentioned the intradural posterior fossa and the midline as the preferential localization of these tumors. 1,7 In contrast, extradural dermoid cysts are a much rarer entity.…”