Elsevier

Surgical Neurology

Volume 57, Issue 6, June 2002, Pages 391-398
Surgical Neurology

Neoplasm
Ruptured intracranial dermoid cysts

https://doi.org/10.1016/S0090-3019(02)00723-1Get rights and content

Abstract

BACKGROUND

Intracranial dermoid cysts are rare congenital neoplasms that are believed to arise from ectopic cell rests incorporated in the closing neural tube. The rupture of an intracranial dermoid cyst is a relatively rare event that typically occurs spontaneously. In the past it was believed that rupture is always fatal, a hypothesis that is not supported by more recently reported cases. The symptoms associated with rupture vary from no symptoms to sudden death.

METHODS

The present paper analyzes published cases of ruptured intracranial dermoid cysts in terms of their age profile and their clinical presentation and describes an additional case.

RESULTS

Analysis of published cases revealed headache (14 out of 44 patients; 31.8%) and seizures (13 out of 44 patients; 29.5%), to be the most common signs of rupture followed by, often temporary, sensory or motor hemisyndrome (7 out of 44 patients; 15.9%), and chemical meningitis (3 out of 44 patients; 6.9%).

CONCLUSION

Headache occurred primarily in younger patients (mean age 23.5 ± 9.3 years), whereas seizures primarily occurred in older patients (mean age 42.8 ± 11.3 years). The patients with sensory or motor hemisyndrome associated with rupture of an intracranial dermoid cyst showed a more homogeneous age distribution (mean age 38.4 ± 23.5 years).

Section snippets

Case report

A 16-year-old female complained of palsy of the right arm and right-sided facial numbness in December 1999. The symptoms persisted for a couple of hours. A repeat episode occurred one month later, whereupon her physician referred the patient for magnetic resonance (MR) imaging of the head. The MR examination demonstrated a mass in the left supra- and parasellar region on the left, and the patient was hospitalized.

On admission, the patient was in good general condition. No neurologic deficits

Discussion

Intracranial dermoids are reported to account for 0.04% to 0.25% of all intracranial neoplasms. They are four to 10 times less common than intracranial epidermoid cysts 3, 7, 18, 26, 27, 29, 30. The term “dermoid cyst” often causes confusion because it is sometimes wrongly used synonymously with the terms “epidermoid,” “pearl tumor,” and “teratoma.”

The presence of hair follicles, sebaceous and sweat glands in the cyst wall distinguishes dermoid from epidermoid cysts. Both arise from the

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