Ruptured intracranial dermoid cysts: A retrospective institutional review

Shashidhar, Abhinith; Sadashiva, Nishanth; Prabhuraj, A R; Rao, Kannepalli Narasingha; Tiwari, Sarbesh; Saini, Jitendra; Shukla, Dhaval; Devi, Bhagavatula Indira

doi:10.1016/j.jocn.2019.04.025

Cited by 16 publications

(14 citation statements)

References 21 publications

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“…A handful of cases in the literature have documented hydrocephalus following intracranial dermoid cyst rupture ( Table 1 ). Some of these studies at least partially credited disseminated fat for playing a role in the development of hydrocephalus ( 8 , 9 , 11 , 19 , 20 , 22 ). In a report of a ruptured right parasellar dermoid cyst that led to convulsive seizures a few years after removal, Fukui commented that the symptoms were likely due to residual fat particles in the Sylvian cistern, and concluded that these should be removed as much as possible at the time of surgery ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Background: Ruptured intracranial dermoid cysts are extremely rare. Standard treatment consists of endonasal decompression or craniotomy with evacuation and copious irrigation of subarachnoid spaces to remove any disseminated cystic contents. Disseminated fat particles in the subarachnoid space may be the cause of further sequalae, including the subsequent development of chemical meningitis and hydrocephalus. Here, we present a case of ruptured suprasellar dermoid cyst treated with craniotomy for emergent optic nerve decompression, followed by postoperative hydrocephalus successfully treated with lumbar drain.Case description: We describe a 30-year-old man with a history of migraines who presented with acute onset of headache, photophobia, nausea, vomiting, and vision loss in the left eye. Head CT and brain MRI demonstrated a ruptured suprasellar dermoid cyst with associated mass effect on the optic nerves and frontal lobes as well as fat attenuation material within the subarachnoid spaces. The patient underwent left frontotemporal craniotomy for cyst resection and developed non-obstructive hydrocephalus on postoperative day 1, refractory to external ventricular drainage. Placement of a lumbar drain cleared the subarachnoid space of debris derived from the ruptured dermoid cyst, and the hydrocephalus resolved. The patient did not require permanent CSF diversion.Conclusions: Intracranial dermoid cysts are uncommon, and rupture is a rare event. Standard surgical treatment with craniotomy for evacuation may leave disseminated dermoid contents and fat particles throughout the subarachnoid spaces. We highlight a case of ruptured suprasellar dermoid cyst with postoperative communicating hydrocephalus treated with lumbar drain when external ventricular drain (EVD) was ineffective. Review of the current literature reveals inconsistent findings on the effects of remaining fat particles. In cases with clinical evidence of increased intracranial pressure due to non-obstructive hydrocephalus attributable to chemical meningitis, temporary lumbar drainage is an option to be considered before committing the patient to permanent shunting.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…The CSF examination findings of high protein levels, low glucose level, and neutrophilic pleocytosis in patients with chemical meningitis resemble those of patients with bacterial meningitis ( 3 , 4 ); however, the presence of multiple lipid droplets in the subarachnoid space, visualized on MRI scanning, helped in making a differential diagnosis. High-intensity particles visible on both T1-WI and T2-WI/FLAIR, but absent on fat-suppressed MRI, is a characteristic radiological pattern ( 5 ). Lipid particles presenting as artifacts, known as “chemical shift artifacts” on SWI, were also the main indicators of diagnosis ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…High-intensity particles visible on both T1-WI and T2-WI/FLAIR, but absent on fat-suppressed MRI, is a characteristic radiological pattern ( 5 ). Lipid particles presenting as artifacts, known as “chemical shift artifacts” on SWI, were also the main indicators of diagnosis ( 5 ). Steroid therapy has been reported as a potential treatment strategy for chemical meningitis caused by a dermoid cyst rupture ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

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Chemical Meningitis after a Golf Swing-induced Dermoid Cyst Rupture

et al. 2020

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A 51-year-old man developed a sudden headache during golf practice, followed by a high fever. He was admitted with suspected neutrophilic meningitis and was diagnosed with chemical meningitis caused by a dermoid cyst rupture based on the characteristic magnetic resonance imaging (MRI) findings, which showed multiple lipid droplets in his ventricle and cistern. His repetitive golf-swing motion was suggested to be the cause of his dermoid cyst rupture. On MRI, the lipid droplets appeared to have migrated by gravity because of the body position. Therefore, the body position should be considered to prevent obstructive hydrocephalus by lipid droplets after a dermoid cyst rupture.

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“…Clinically, seizure (44%) and headache (67%) are common [ 5 , 8 ]. Two types of seizures have been described in previous reports.…”

Section: Introductionmentioning

confidence: 99%

Non-Ruptured Temporal Lobe Dermoid Cyst Concomitant with Focal Cortical Dysplasia Causing Temporal Lobe Epilepsy—A Case Report and Literature Review

et al. 2021

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Background: Intracranial dermoid cyst is a rare, benign, nonneoplastic tumor-like lesion that could cause seizures, headache, and hydrocephalus. We hypothesized that the temporal lobe dermoid cyst in combination with other factors were causing the epileptic seizure. Methods: We encountered a 17-year-old girl with anti-seizure medication-resistant epilepsy secondary to dermoid cyst located in the temporal region depicted on magnetic resonance imaging (MRI). She showed neither symptoms of meningitis nor rupture of the cyst according to serial MRI. We hypothesized that temporal lobe dermoid cyst in combination with other factors, such as focal cortical dysplasia (FCD), etc., was causing epileptic seizures in this case. She underwent dermoid cyst removal surgery with resection of the tip of the antero-inferior temporal lobe. Results: Histopathological study showed multiple small intramedullary dermoid cysts in the left antero-inferior temporal lobe in addition to MRI lesions and FCD. Conclusion: A patient with medically intractable epilepsy secondary to left temporal lobe dermoid cyst showed multiple intramedullary dermoid cysts and focal cortical dysplasia that might have interacted to create epileptogenicity. To our knowledge, this is the first case report of dermoid cyst concomitant with FCD.

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Ruptured intracranial dermoid cysts: A retrospective institutional review

Cited by 16 publications

References 21 publications

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

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

Chemical Meningitis after a Golf Swing-induced Dermoid Cyst Rupture

Non-Ruptured Temporal Lobe Dermoid Cyst Concomitant with Focal Cortical Dysplasia Causing Temporal Lobe Epilepsy—A Case Report and Literature Review

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