Intraorbital Expansion of an Intradiploic Frontal Epidermoid Cyst: A Case Report and Short Review of the Literature

Intradiploic epidermoid cyst in a 15-year-old female: a rare case report

Introduction and importance

Intradiploic epidermoid cysts are rare, benign, slow-growing lesions that originate from the inclusion of ectodermal elements during the closure of the neural tube. This article reports a case of a rare, benign intradiploic epidermoid cyst.

Case presentation

A 15-year-old female patient had a cystic swelling located in the occipital region, caused the patient to experience a progressively enlarging swelling and intense headaches. It was diagnosed as intradiploic epidermoid cyst on MRI. Surgery was done and removed. Postoperative outcomes were very good.

Clinical discussion

Intradiploic epidermoid cysts are quite rare. Although these cysts usually happen because of this ectoderm inclusion, the patient's history of falling raises questions about whether trauma could have caused it too. We really need more research to see if there's a connection between injuries & these types of cysts.

Conclusion

The importance of prompt diagnosis and appropriate surgical intervention is necessary while highlighting the rarity of these lesions and their potential traumatic origin.

Intradiploic epidermoid cyst in the skull: Case report and systematic review

Intradiploic epidermoid cysts are rare, benign tumors, accounting for less than 1% of all intracranial tumors. Due to their scarcity, we are reporting a case of an intradiploic epidermoid cyst and reviewing several similar cases in the literature to provide a better description of this tumor and analyze its clinical and radiological features. We conducted a search on the PubMed database for studies published between January 2010 and February 2023, including studies of nontraumatic and noniatrogenic calvarial cysts. We found a total of 34 studies and 41 patients, with an average patient age of 42.5 years. Common symptoms included painless masses, headaches, and seizures. The occipital, frontal, and parietal regions were the most common locations for these tumors. Some patients experienced complications such as otitis media, infection, or extension into the orbit and brain. Surgical resection was performed in all cases except for 2 patients with contraindications to surgery. Histological examination confirmed the diagnosis of an intradiploic epidermoid cyst. These cysts are rare skull lesions and can potentially cause neurological deficits due to their mass effect. If incompletely resected, they may also undergo malignant transformation. No single institution has accumulated enough cases to describe this rare tumor accurately. Therefore, through this review, we aim to highlight this tumor's epidemiological, clinical, and radiological features.

Tension Pneumocephalus With Acute Cerebellar Symptoms Due to an Intradiploic Epidermoid Cyst Eroding the Mastoid Bone

This case report presents a unique presentation of an intradiploic epidermoid cyst (IDEC) in a 55-year-old female. She presented with acute cerebellar symptoms triggered by a Valsalva maneuver. IDECs are a rare type of intracranial epidermoid cysts. They are benign and have a slow growth pattern that translates into progressively developing symptoms instead of acute symptoms. Symptoms include local deformities, focal neurologic deficits, and pain. This patient developed acute cerebellar symptoms due to erosion of the mastoid bone that created a pathway between the eustachian tube and the intracranial space via the mastoid air cells. Consequently, tension pneumocephalus emerged via a ball-valve effect that caused a significant mass effect in the posterior fossa. Surgical resection of the IDEC and closing of the mastoid air cells resulted in symptom relief by restoring the integrity of the intracranial-extracranial barrier. This case highlights that a higher level of vigilance is warranted for an IDEC in the proximity of aerated bone structures, such as the mastoid air cells and the paranasal sinuses, and that a more proactive approach is advocated.