Non-communicating hydrocephalus decades after spinal dermoid resection

Ajeet Gordhan,Hetal Patel,Michael A Casey

doi:10.5348/ijcri-2013-03-286-cr-7

Abstract

Introduction: We present a case of acute non communicating hydrocephalus due to fat droplet obstruction of the cerebral aqueduct, fiftyone years after resection of a spinal dermoid tumor. Case Report: A 71yearold male presented with sudden onset of neck pain and gait instability. He had prior complete surgical resection of a cervical dermoid cyst in 1959. Follow up magnetic resonance imaging (MRI) in 2007 showed intracranial fat signal droplets within the posterior fossa. An MRI examination obtained in 2012 demonstrated hydrocephalus consequent to fat droplet obstruction at the aqueduct of sylvius which was not present in MRI study done in 2007. Conclusion: To our knowledge there are no published reports of delayed post spinal dermoid resection subarachnoid fat droplet migration leading to acute noncommunicating hydrocephalus.

Highlights

We present a case of acute non communicating hydrocephalus due to fat droplet obstruction of the cerebral aqueduct, fiftyone years after resection of a spinal dermoid tumor
Delayed subarachnoid fat droplet migration after spinal dermoid resection leading to acute noncommunicating hydrocephalus has not been previously reported in literature
Review of routine follow up magnetic resonance imaging (MRI) scan done in 2007 revealed recurrence of dermoid fat droplets within the cervical spine with cephalad migration into the subrarachnoid spaces of the posterior fossa, without hydrocephalus (Figure 1A)

Summary

INTRODUCTION

Intracranial dermoid cyst rupture leading to non communicating hydrocephalus is well documented in literature [1]. There are only two case reports of ruptured spinal dermoid cysts leading to hydrocephalus. In each of these cases fat droplet obstruction within the subarachnoid space occurred prior to resection of the cysts [2]. Delayed subarachnoid fat droplet migration after spinal dermoid resection leading to acute noncommunicating hydrocephalus has not been previously reported in literature. The medical and surgical history was otherwise noncontributory On physical examination, he was normotensive, alert and orientated with fluent speech. Review of routine follow up magnetic resonance imaging (MRI) scan done in 2007 revealed recurrence of dermoid fat droplets within the cervical spine with cephalad migration into the subrarachnoid spaces of the posterior fossa, without hydrocephalus (Figure 1A). The hydrocephalus and the patient’s symptoms resolved after a ventriculoperitoneal shunt was placed

Findings

DISCUSSION

CONCLUSION