Giant intracranial dermoid cyst: Case report and review of the literature on intracranial dermoids and epidermoids

Endoscopic Endonasal Surgery for Dermoid Cysts Arising From the Middle Cranial Fossa Floor: A Rare Case Series

OBJECTIVE

Dermoid cysts (DCs) are congenital, slowly growing, and may cause nervous system symptoms. Related literature is limited and mainly includes case reports. We report a case series of DCs originating from the middle cranial fossa floor (MCFF) and investigate their demographic information, clinical characteristics, imaging findings, surgical procedures, and prognostic outcomes.

METHODS

We reviewed the patients with DCs arising from the MCFF undergoing endoscopic endonasal surgery (EES) in our center between 2012 and 2022.

RESULTS

A total of 5 patients with DCs were enrolled (2 males and 3 females), with a mean age of 46.2 years at the onset. All DCs originated from the MCFF with 1 case involving the middle cranial fossa bone and another 1 case affecting the dura mater. One (20.0%) patient had neurological involvement. After admission, all patients received EES with a total resection rate of 100.0% (5 of 5). After a median follow-up of 73.2 months, all patients achieved complete clinical and radiological improvements. No surgical-related complications or relapses were observed during the long-term follow-up.

CONCLUSION

Endoscopic endonasal surgery is considered a safe and effective approach for the treatment of DCs in the MCFF. A larger sample size and longer follow-up time are needed.

An Intracranial Extradural Dermoid Cyst Presenting with Two Dermal Sinuses and an Abscess in a Child

Dermoid cysts account for only a small fraction of intracranial masses, with extradural dermoid cysts being considered a much rarer entity than those located intradurally. Intracranial dermoid cysts vary in clinical presentations: some maybe asymptomatic whilst others harbor features of raised intracranial pressure, neurological deficits, or even aseptic meningitis. Dermoid cysts may also present with cutaneous lesions. Herein, we report a rare case of a 1-year-old female presenting with a midline, scalp abscess. Brain MRI revealed an intracranial, extradural tumor, with features suggestive of a dermoid cyst, unusually located in the crista galli, and complicated by the formation of two cutaneous sinus tracts. After identification and characterization by MRI, bitemporal craniotomy was performed with complete excision of the mass and sinus tracts. Histological analysis confirmed dermoid cyst as the final diagnosis. Postoperatively, the patient recovered fully and had no evidence of recurrence in subsequent visits. The case mentioned above highlights the rarity of such a presentation for an intracranial extradural dermoid cyst and the vitality of early imaging for midline cutaneous lesions for identification of intracranial extensions and avoidance of detrimental consequences.

Intramedullary dermoid cyst with relatively atypical symptoms: a case report and review of the literature

Background

Intraspinal dermoid cysts are rare and benign tumors that occur primarily due to the defective closure of the neural tube, an ectodermal derivative, during the process of development. They are slow-growing tumors manifesting in the second and third decades of life.

Case presentation

We present here a case of a 14-year-old Sindhi boy with a six-month history of paraparesis of the lower limbs and a progressive loss of power of grade 3/5, and hypoesthesia in the L4/L5 dermatomes of his right lower limb. A plain magnetic resonance imaging scan revealed a well-demarcated intraspinal intramedullary cyst containing an abscess at the level of T12 and L1 causing localized cord compression, which was producing the symptoms. Near total excision of the cyst was successfully performed and was sent for biopsy, which revealed keratinocytes and keratin flakes. With one month of follow-up, along with physiotherapeutic management, the patient gradually improved and was able to walk without support.

Conclusions

Critical evaluation of every case with aggravating symptoms should be carried out, and neurological and radiological examinations should be conducted to ensure the well-being of patients.

Intracranial dermoid cysts: variations of radiological and clinical features

BACKGROUND

Intracranial dermoid cysts are uncommon, and their clinical features as well as surgical management differ from patient to patient. Dermoids are generally benign lesions, but may cause spontaneous complications such as meningitis and/or hydrocephalus due to rupture and epileptic seizures depending on their location. Little has been reported about characteristic imaging findings with resulting therapeutic considerations, and only a few reports exist about associated hydrocephalus. Imaging modalities have changed and can facilitate differential diagnosis and follow-up if applied correctly. In this paper, we attempt to contribute our clinical experience with the management of dermoid cysts.

PATIENTS AND METHODS

The charts of five men and two women with intracranial dermoid cysts were retrospectively reviewed. The patients were treated between September 1993 and September 2006. Selected patients are presented in detail.

RESULTS

Tumour location, size and radiographic characteristics varied in each patient. Clinical presentations comprised focal neurological deficits as well as epileptic seizures, persistent headache, mental changes and psycho-organic syndromes. One patient underwent delayed ventriculo-peritoneal shunting after ruptured fatty particles caused obstructive hydrocephalus. Despite dermoid rupture into the subarachnoid space, three patients never developed hydrocephalus. Diffuse vascular supra-tentorial lesions were seen in one patient as a result of aseptic meningitis. Diffusion-weighted imaging (DWI) hyperintensity in dermoids is related to decrease of water proton diffusion and should be used for both the diagnosis and follow-up of this lesion.

CONCLUSION

Although dermoid cysts are known to be benign entities per se, their rupture can cause a wide range of symptoms including aseptic meningitis and/or hydrocephalus. This may be due to intraventricular obstruction and/or paraventricular compression. While rupture does not necessarily bring about hydrocephalus, radical removal of the tumour and close monitoring of ventricular size is required. Although not widely recognised as such, DWI is considered to be a useful imaging modality in the diagnosis and follow-up of dermoids.

Extradural dermoid tumor of the petrous apex. Case report

Dermoid cysts are rare, benign, congenital tumors. Most case series thus far have featured intradural tumors. The authors report on a case of an extradural dermoid tumor of the middle cranial fossa with osseous invasion, successfully removed using a left subtemporal extradural approach. The clinical presentation, histological features, radiological findings, and management of this unique case are described.

Sylvian fissure dermoid cyst with intratumoral hemorrhage: case report

It is rare for a dermoid cyst to develop intratumoral hemorrhage. A 61-year-old woman had a sudden-onset left hemiparesis and slow response to verbal requests for one week when unenhanced computed tomography scanning revealed a mixed iso- and hypo-dense heterogeneous lesion in the right fronto-temporal area. T1-weighted magnetic resonance imaging (MRI) of the brain showed a mixed hyper- and hypo-intense tumor in the right fronto-temporal area. The tumor became hyperintense on T2-weighted MRI and was faintly enhanced at tumor periphery on T1-weighted MRI. The tumor was excised and pathological examination revealed a dermoid cyst with intratumoral hemorrhage. The post-operative course was complicated by hemorrhage in the tumor bed, which was evacuated immediately. The patient improved and could walk without support two weeks after the second operation. After 1 year of follow-up, she was well and without neurological deficits. To the best of our knowledge after a literature review, only two previous cases of dermoid cyst have featured intratumoral hemorrhage.

Ruptured “giant” supratentorial dermoid cyst

Intracranial dermoid and epidermoid cysts are rare lesions formed from the inclusion of ectodermal elements during neural tube closure. Although not entirely consistent, imaging characteristics on CT and MRI can aid differentiation of dermoids and epidermoids, as can age at presentation, location and tendency to rupture. The distinction between dermoid and epidermoid lesions is important prognostically and may impact on surgical management as a subtotally resected dermoid is less likely to recur than its epidermoid counterpart. The distinction of large dermoid lesions as "giant" adds little to information regarding the natural history or prognosis of these lesions and should be abandoned.

Magnetic resonance imaging of a medullary dermoid cyst with secondary hydrocephalus in a dog

Magnetic resonance images were acquired of the brain of a 7-year-old male Golden Retriever with hydrocephalus secondary to a medullary lesion. Images were acquired prior to and 4 weeks following surgical treatment for the hydrocephalus, and the dog was euthanased following the second imaging session. The MR images demonstrated a medullary lesion with patchy but predominantly hyperintense signal with both T1- and T2-weighting, within which small areas of low signal were scattered. There was little edema associated with this lesion and no enhancement with gadolinium. Postmortem examination revealed the medullary mass to be a dermoid cyst. Several small nodular lesions were identified within the central nervous system on the magnetic resonance images whose origin was uncertain on postmortem examination.

Three-dimensional chemical shift-selective MRI of a ruptured intracranial dermoid cyst

We report a man with a ruptured intracranial dermoid cyst, suffering from headache, nausea, vomiting and a generalised seizure. MRI was performed before and 2 weeks after surgical resection. On T1-weighted images the tumour gave high signal, as did fatty material in the frontal and parietal brain sulci. Identification of this hyper-intense material as lipids was possible by chemical-shift-selective 3D gradient-echo imaging, which provided excellent contrast between the subarachnoid lipids and the adjacent normal brain, with a good spatial resolution. Possible complications of subarachnoid and intraventricular lipid particles after dermoid cyst rupture are discussed and the diagnostic value of 3 D chemical-shift-selective additional to conventional T-1-weighted spin-echo images in identification of even small amounts of fat is emphasised.

Craniocerebral epidermoid and dermoid tumours: a review of 32 cases

We reviewed 22 epidermoid and 10 dermoid tumours of the skull and brain from patients operated on consecutively at Henry Ford Hospital between 1975 and 1991. There were 19 intradural (16 epidermoid, 3 dermoid) and 13 extradural (6 epidermoid, 7 dermoid) lesions. The average age at presentation was 35 years for patients with epidermoids and 15 years for those with dermoids. Common clinical presentations for patients with intradural lesions included headache, visual deficits, and seizures, whereas patients with extradural lesions harbored asymptomatic scalp masses. All patients with intradural lesions were investigated with computed tomography (CT) and cerebral angiography, and 8 patients underwent magnetic resonance imaging (MRI). Total resection was possible in 12 (92%) of 13 extradural tumours, all with excellent outcomes. Eight (42%) of the intradural tumours were completely resected. Overall, with the intradural tumours we had good to excellent results in 17 patients (90%), poor results in 1 (5%), and 1 death (5%). Re-operation was needed in 5 intradural recurrences (26%) with deterioration in only one patient's neurologic status postoperatively. From a review of ours and others' data, we conclude that 1) these tumours have an insidious onset despite significant size and mass effect as demonstrated by imaging studies; 2) CT, angiography, and particularly MRI help to define the extent of subarachnoid tumour spread and involvement of neurovascular structures, thus permitting better surgical planning; 3) a significant number of intradural tumours are difficult to excise because of their adherence to neurovascular structures, and thus are related to higher morbidity and mortality; and 4) because of extremely slow growth, complete tumour resection should not be the goal at the risk of injury to neurovascular structures.

CT and MRI of ruptured intracranial dermoids

Two patients with ruptured intracranial dermoids, examined with both CT and MRI are reported. Clinical presentation was transient cerebral ischemia in one patient and acute meningeal signs in the other. CT scan showed typical fat density of the tumor and the subarachnoid space. On MRI both the tumor and the subarachnoid fat, were strongly hyperintense on T1-weighted images.

Dermoid cyst of the scalp: intracranial extension

Intracranial dermoids are rare and are usually associated with cutaneous scalp lesions. Five hundred forty-two scalp lesions were treated in a 22-year period, and were associated with intracranial lesions in three cases. High-risk cases can be identified by clinical and radiological features, confirmed by a computed tomography scan, and then referred for neurosurgical treatment.

Epidermoid tumors. Review of the literature

Reports of epidermoid tumors from 1965 through 1986 were reviewed with emphasis on new and unusual findings. Clinical data considered were rapid onset, rare symptoms, size and rate of growth, and complications. Uncommon locations included multiple sites in one patient and the anterior fontanelle. The radiologic data from computed tomography were the main contributors to diagnosis. An immunohistochemical test disclosed that cells of craniopharyngiomas are keratin-positive. Histologically benign epidermoids can behave as highly malignant tumors, and can become carcinomatous. Postoperative results for benign tumors were often excellent. Evidence was presented of the close relation among epidermoid and dermoid tumor, craniopharyngioma, ameloblastoma (adamantinoma), Rathke's cleft cyst, and aural cholesteatoma.

Intracranial teratoma associated with agenesis of the corpus callosum

Several intracranial tumors are known to occur in conjunction with agenesis of the corpus callosum. We report the occurrence of a teratoma with callosal agenesis, an association not previously described, and suggest that the tumor's ventral location may serve to differentiate it from other lesions.

Intracranial intradural epidermoids and dermoids. Surgical results of 38 cases

This report covers 38 Cases of intradural dermoids (4 cases) and epidermoids (34 cases). In most cases the clinical course extended over several years. At the time of admission to the clinic only 9 patients had purely local symptoms; symptoms from adjacent areas were present in 15 cases and elevated intracranial pressure in 13. Of the 35 operated patients, 16 were able to work again, and 7 died after the operation. Best results are achieved in cases involving young patients, in cases where the tumor is situated in the cerebral hemisphere, and in cases where the tumor can be totally removed. In recent years advances in diagnostic, surgical and anaesthetic techniques have lowered the lethality rate. Computed tomography is especially useful for an early diagnosis.

Cranial computed tomography of epidermoid and congenital fatty tumors of maldevelopmental origin

The computed tomographic and clinical findings in 17 patients with fatty intracranial tumors and in 10 patients with epidermoid tumors, all of maldevelopmental origin, are presented. Fat was found in lipomas (the most frequent), dermoids, and teratomas. Differentiation between these tumors is discussed on the basis of density, calcification, location, and symptomatology.