Intracranial complications of midline nasal dermoid cysts

Abstract

Nasal midline dermoid cysts are considered benign swellings. When an intracranial extension exists, infection can lead to deleterious complications. It is important for health care practitioners to be aware of this imminent risk. Suspicion of a nasal midline dermoid cyst should prompt a careful clinical work-up with an ultrasound followed by CT or MRI imaging. The treatment is complete excision to avoid disastrous complications and recurrences.

Nasal dermoid cyst with intracranial extension in a cat

“…9 A smaller number of nasal dermoid cysts in people have an intra cranial extension; progressive growth and/or infection of dermoid cysts can cause facial deformity, local infection, meningitis and/or brain abscessation. 8,10–12…”

“…9 A smaller number of nasal dermoid cysts in people have an intra cranial extension; progressive growth and/or infection of dermoid cysts can cause facial deformity, local infection, meningitis and/or brain abscessation. 8,[10][11][12] Nasal dermoid cysts are described infrequently in the veterinary literature, with most cases presenting for evaluation of primarily dermatological complaints from cyst growth, or recurrent infection of the area and surrounding structures. 9 To date, there have been no published reports in the veterinary literature of neurological signs secondary to a nasal dermoid cyst.…”

Combined minimally invasive surgical management of a nasal dermoid sinus cyst affecting the frontal sinus: literature review and new classification.

“…Most NDSCs have an extra-axial extension only to the attaching dura or cerebral falx; however, in extremely rare cases, there is an intra-axial extension with a direct parenchyma connection [1,15]. The majority of NDSC cases are diagnosed during childhood between 2 and 3 years of life [11,[16][17][18]. This is primarily due to the presence of characteristic signs and symptoms (e.g., external nose deformation or pathognomonic hair concentration protruding from the sinus canal on the skin above the lesion, often accompanied by periodic 'cheesy'-like sebaceous and keratin discharge) [10,11,13,18].…”

“…The majority of NDSC cases are diagnosed during childhood between 2 and 3 years of life [11,[16][17][18]. This is primarily due to the presence of characteristic signs and symptoms (e.g., external nose deformation or pathognomonic hair concentration protruding from the sinus canal on the skin above the lesion, often accompanied by periodic 'cheesy'-like sebaceous and keratin discharge) [10,11,13,18]. NDSCs diagnosed in adulthood are rare, with only two published cases involving the frontal sinus [4,[19][20][21][22].…”

“…Treatment of NDSCs is based on the possibility of surgical excision, which depends on the location, size, and intracranial extension of the lesion [2,16]. Complications of untreated NDSCs include spontaneous local infection with frontal bone osteomyelitis, and abscess formation, which can be incorrectly interpreted as a lacrimal sac abscess when medial canthus swelling is present [10,18,22,29]. Moreover, long-lasting inflammation can lead to deformations of the nasal bones and cartilage, or even atrophy [8,13].…”