Recurrence of ruptured intracranial epidermoid cyst - A rare case report and presentation

INTRODUCTION

Intracranial epidermoid cysts are congenital tumors that develop from ectodermal remnants during neuroembryogenesis between the third and fifth weeks of gestation. These tumors are benign and usually present with local mass effect. Here, we present a rare case of ruptured intracranial epidermoid cyst with recurrence.

PRESENTATION OF CASE

A 55 years old male patient was brought to emergency with a history of headache and loss of consciousness for 1 h. Radiological imaging showed the features suggestive of ruptured intracranial epidermoid cyst which was operated. Two years later the patient re-presented with headache for 4-5 days where repeat MRI revealed recurrence of the tumor.

DISCUSSION

Epidermoid cysts are very slow growing tumor at a linear rate due progressive accumulation of normally dividing epidermal cells. These tumors often reach a large size before the onset of symptoms. At times, the tumor capsule may show infiltration to the brain parenchyma and tight adherence to neurovascular structures which leads to the incomplete removal of the tumor capsule leading to recurrence of tumor.

CONCLUSION

Rupture of intracranial epidermoid cyst is a rare phenomenon and recurrence of this tumor in patients is even infrequent.

Ruptured intracranial dermoid cysts: clinical, radiographic, and surgical features

OBJECTIVE

Intracranial dermoid cysts are pathologically characterized by a thick, stratified squamous epithelium cyst wall containing dermal elements. Rupture into the subarachnoid spaces and ventricles is extremely rare. We review the clinical, radiographic, and surgical features of eight ruptured dermoid cysts.

METHODS

We retrospectively evaluated five surgically treated patients with pathologically proven ruptured dermoid cysts. Clinic notes, operative reports, and neuroimaging, including initial computed tomographic and magnetic resonance imaging scans, were reviewed. Imaging was also available on three outside patients reviewed by members of our radiology department.

RESULTS

The most common presentations were headaches (57%) and seizures (42%), followed by hydrocephalus (29%) from intraventricular rupture. These lesions were consistently hypodense on computed tomographic scans and hyperintense on T1-weighted images with minimal to no enhancement after gadolinium administration. Disseminated fat droplets were present in the subarachnoid space in both cerebral hemispheres in all patients, and five patients had intraventricular rupture with fat-fluid levels in the ventricles. Gross to near-total resection of the primary lesion was achieved in all five surgically treated patients treated at our institution. Four patients had remnant tumor capsules adherent to neurovascular structures that were unresectable. Repeat resection was performed for one recurrence; there were no further recurrences during a follow-up period of 2 to 134 months (mean, 65.6 mo). Two patients with preoperative hydrocephalus eventually required ventriculoperitoneal shunting.

CONCLUSION

Ruptured intracranial dermoid cysts represent 0.18% of all central nervous system tumors surgically treated in our institution during a 12-year period. The presence of disseminated fat droplets in the subarachnoid space or ventricles on neuroimaging is diagnostic for a ruptured dermoid cyst. Gross total removal is achievable; however, residual tumor capsules adherent to neurovascular structures should be left behind to minimize complications.

Ruptured intracranial dermoid cysts

Rupture of intracranial dermoid cysts (RICDC) is a rare phenomenon. The mechanism of rupture, pathophysiology of fat in the ventricles and subarachnoid spaces, possible complications, and proper management of such conditions are proposed on the basis of a review of the literature and experience with two cases of ruptured intracranial dermoid cysts (One was in the pineal region, while another was in the fourth ventricle). It is concluded that rupture of intracranial dermoid cysts is usually spontaneous and non-fatal. Persistence of fat in the subarachnoid spaces postoperatively may last asymptomatically for years. Surgery is the only way to deal with these benign lesions. If the capsule is adherent to vital areas, incomplete removal is advised as recurrence and malignant transformation are unlikely to occur.

Accumulation of intraventricular fat in an intracranial epidermoid tumor: case report

OBJECTIVE AND IMPORTANCE

A fat component within the ventricles or subarachnoid space in fat-containing tumors such as an epidermoid or a dermoid has been observed in rare instances. However, there have been no reports regarding an increase in the size of such a fat component. We describe the case of an epidermoid tumor with intraventricular fat that showed an increase in size and amount.

CLINICAL PRESENTATION

A 26-year-old woman was admitted with headache and diplopia. Computed tomography and magnetic resonance imaging of the brain revealed a fat-containing suprasellar tumor and widespread fat globules in adjacent sulci and cisterns and within the frontal horn of the lateral ventricle.

INTERVENTION

The patient underwent a pterional craniotomy. Removal of the suprasellar tumor was nearly total. Histopathological examination revealed an epidermoid tumor. Sequential magnetic resonance imaging throughout the ensuing 65-month period revealed no evidence of tumor recurrence; however, the intraventricular fat remained and increased in size. The patient underwent surgery via the transcallosal approach at 69 months after the initial operation, and the presence of free-floating oily fat globules was confirmed.

CONCLUSION

In the case of a fat-containing tumor with free fat in the cerebrospinal fluid spaces, careful serial examination is necessary, with particular attention to the possibility of changes in size.

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.

Ruptured intracranial dermoid tumor secondary to closed head trauma. Computed tomography and magnetic resonance imaging

A patient with an intracranial dermoid tumor that ruptured secondary to closed head trauma is described. Intracranial dermoid tumors (cysts) have been reported to rupture spontaneously during or following surgery. To the authors' knowledge, rupture of a dermoid cyst following closed head trauma has not been reported.