Abstract
Teratomas are germinal cell tumors originating from all three germ cell layers. When intracranial in location, they typically occur in the pineal or suprasellar regions. Ruptured intracranial teratomas are exceedingly rare. The authors report a case of a 34-year-old woman with a ruptured fourth ventricular mature teratoma that was treated with open surgery. The patient initially presented complaints of headache, nausea, and dizziness. CT scan demonstrated a mixed density lesion in the fourth ventricle and hypo dense lesions in bilateral lateral ventricles. MRI imaging revealed a complex fourth ventricular lesion and high T1 signal bilaterally in the lateral ventricles. A ruptured fourth ventricular teratoma was suspected and the patient was taken for surgery. Histopathology confirmed the diagnosis. Due to CSF leaking from her wound she ultimately underwent a ventriculoperitoneal shunt procedure several days later for persistent pseudomeningocele and hydrocephalus. A review of the literature is performed. Spontaneous rupture of intracranial mature teratomas is seldom encountered. The later than typical presentation may be attributed to the tumor’s unusual location, precluding the more typical visual or endocrine abnormalities which may have otherwise resulted in an earlier diagnosis.
Highlights
Intracranial teratomas are very rare mass lesions
The later atypical presentation may be attributed to the tumor’s unusual location, precluding the more typical visual or endocrine abnormalities which may have otherwise resulted in an earlier diagnosis
Found elements include fat, bone, cartilage, teeth, and hair. They have been reported to occur in the lateral ventricles, pineal region, suprasellar regions, and the posterior fossa, while teratomas arising within the fourth ventricle have been rarely reported [6,7,8,9,10,11,12]
Summary
Intracranial teratomas are very rare mass lesions. Though there are reports of ruptured extracranial teratomas in the literature [13], spontaneous rupture of intracranial mature teratomas is seldom encountered. The authors report a ruptured fourth ventricular mature teratoma with its content migrating superiorly into the bilateral lateral ventricles. MRI confirmed the presence of a fat-containing mass in the fourth ventricle, with scattered fat droplets in the same places seen on CT (Figure 1C,1D). The final pathology report confirmed the diagnosis of a mature cystic teratoma (Figure 2A-2C). She remained neurologically intact following the procedure, the patient was discharged to inpatient rehabilitation at physical therapy’s recommendation. She returned several weeks later with a pseudomeningocele and CSF leaking from her wound. She was taken back to the operating room for duraplasty, underwent a ventriculoperitoneal shunt procedure several days later for persistent pseudomeningocele and hydrocephalus
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