Unusual Cause of Cerebellar Abscess: Occipital Dermal Sinus and Dermoid Cyst

Martens, Frederic; Ectors, P; Noël, Pierre; Hanquinet, Sylviane; Faverly, D.

doi:10.1055/s-2008-1052463

Cited by 11 publications

(17 citation statements)

References 2 publications

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“…2), frequently associated with hydrocephalus [8]. The most common bacteria are gram-positive cocci, especially staphylococci, then gram-negative bacilli such as diphtheroids or enterobacteria [5, 8, 13, 16, 20, 22]. A dermal sinus should be suspected in any case of meningitis with an unusual pathogen, such as a coliform one, in the absence of a likely context [4].…”

Section: Discussionmentioning

confidence: 99%

“…In addition to our series, we reviewed the medical literature for clinical and radiological data regarding ODS, selecting cases for which clinical data were available [1, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23]. Statistical analysis was performed with commercially available software (SPSS 9.0.1 for Windows), using a p value of 0.05 for confidence intervals for percent comparison, the Kaplan-Meier method for survival analysis and Spearman’s test for nonparametric correlations.…”

Section: Methodsmentioning

confidence: 99%

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Occipital Dermal Sinuses

Vinchon¹,

Soto-Ares²,

Assaker³

et al. 2001

Pediatr Neurosurg

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Occipital dermal sinuses (ODS) are rare dysraphic lesions resulting from defective separation of the ectoderm and neuroderm. These lesions are often diagnosed at birth and should be treated early because of potentially life-threatening complications. However, the pathogenesis of these rare lesions is still poorly understood, and there is no consensus about the optimal timing of surgery. We reviewed 9 pediatric cases of ODS operated in our department since 1982 and 79 other cases published in the literature during the last 50 years. Thirty-eight percent of these had neurological infection (meningitis or abscess), 22% had purely local infection and 40% were uncomplicated at the time of diagnosis. The incidence of infection was low during the first year of life. MRI was highly valuable to study the extent of the sinus and the content of the cyst. The outcome was regularly favorable after surgery. Surgery should however be undertaken with caution on account of the intimate relationship with venous structures, aggravated by postinfectious scarring when the patient is operated late. Considering the risks associated with surgery in neonates and the low incidence of infection during the first year, we advise performing surgery at around 6 months.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Occipital Dermal Sinuses

Vinchon¹,

Soto-Ares²,

Assaker³

et al. 2001

Pediatr Neurosurg

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“…However, cerebellar abscesses as a complication of posterior fossa dermoid cyst and dermal sinus are exceptional, and only 16 cases are reported in the literature at present [1, 3, 4,6,7,8,9,10,11,12,13,14,15,16]. …”

Section: Discussionmentioning

confidence: 99%

“…Clinical signs of cerebellar abscedation include vomiting, gait disturbance, and somnolence [10]. Because abscess formation generally occurs in babies or small children, these signs and symptoms may also not be considered important, and diagnosis and treatment may be delayed.…”

Section: Discussionmentioning

confidence: 99%

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Posterior Fossa Dermoid Cysts Causing Cerebellar Abscesses

et al. 2007

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Dermoid cysts are uncommon tumors, and posterior fossa dermoid cysts may rarely cause abscess formation or formation of daughter abscesses within the cerebellum. At present, there are only 16 cases with posterior fossa dermoid cysts causing cerebellar abscesses reported in the literature. Two cases, 22 and 14 months old, with posterior fossa dermoid cysts and dermal sinus causing multiple cerebellar abscesses are reported. In the first one, there was also marked hydrocephalus. Retrospective examination of the patients revealed pinpoint-sized dimples in their suboccipital regions. Both patients were treated with antibiotics and underwent posterior fossa surgery. In the patient with marked hydrocephalus, ventriculoperitoneal shunting was performed after treatment of the infection. Both patients were neurologically normal, and there were no complaints, except a light learning difficulty in the patient with ventriculoperitoneal shunting, 133 and 34 months after surgery, respectively. Early detection of congenital dermal abnormalities along the craniospinal axis by routine examination of newborns is highly important before development of serious complications. Because surgery is the only effective treatment modality for these lesions, radical excision should be performed in all cases to avoid tumor recurrence. However, subtotal excision may be performed in selected cases, because the cyst capsule may adhere firmly to vital structures.

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Abscedation of posterior fossa dermoid cysts

et al. 1996

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Dermoid cysts of the posterior fossa are uncommon. When associated with a dermal sinus, these cysts are often diagnosed during early childhood. The main risk of such an association is contamination of the cyst leading to abscedation of the dermoid itself or formation of daughter abscesses within the cerebellar hemisphere. We recently treated a 20-month-old girl who had a congenital dermal sinus leading to an intradural dermoid cyst. In addition to the midline dermoid cyst, computerized tomography revealed an enhancing lesion extending into the adjacent left cerebellar hemisphere. Suboccipital craniectomy was undertaken after 2 days of external ventricular drainage, and the infected dermoid and adjacent cerebellar abscess were excised. Cultures of the operative specimen revealed Corynobacterium aquaticum, Enterobacter sakazakii and Enterobacter cloacae, requiring 6 weeks of intravenous antibiotic therapy consisting of ceftriaxone, penicillin and gentamicin. A diligent literature search revealed only 24 sporadic cases reported over a period of 56 years. All 24 cases were in children (mean age 17 months), and one-third were in infants under the age of 1 year. All but 1 of these patients underwent posterior fossa surgery, with mortality and morbidity rates of 13% and 10%, respectively. Eleven (40%) children had suppuration within the cerebellar parenchyma, while the rest had abscedation of the dermoid cyst alone. Among the cases reviewed S. aureus was the most common agent, occurring with a probability of 64%. Key issues for appropriate management of these benign lesions are discussed.

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Unusual Cause of Cerebellar Abscess: Occipital Dermal Sinus and Dermoid Cyst

Cited by 11 publications

References 2 publications

Occipital Dermal Sinuses

Occipital Dermal Sinuses

Posterior Fossa Dermoid Cysts Causing Cerebellar Abscesses

Abscedation of posterior fossa dermoid cysts

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