Abstract
Background:Dermoid tumors are benign congenital cystic lesions that usually present with local mass effect. Very rarely, they present as spontaneous ruptures. Traumatic rupture of these dermoid cysts is an extremely rare event and only a handful of such cases have been ever reported.Case Description:A 47-year-old female presented to our hospital with a ruptured intracranial dermoid cyst following a mild head injury. The ruptured cyst contents were disseminated into the subarachnoid and intraventricular compartments, resulting in an obstructive hydrocephalus. After medical stabilization, she underwent gross total resection of the cyst using combined transsylvian, transcortical-transventricular, and sub-frontal approaches. A ventriculo-peritoneal shunt was eventually also needed.Conclusion:Traumatic rupture of an intracranial dermoid cyst is an extremely rare event and this is only the fourth such case reported in the literature. We presume that this rupture occurs due to sudden shifts in the cyst sac, which is adherent to some partially mobile intracranial contents. Although computed tomography (CT) is often adequate in making a diagnosis of this entity, magnetic resonance imaging (MRI) provides complete characterization of the extent of lipid dissemination, and is essential for operative planning. Intravenous steroids at presentation are helpful in managing the aseptic meningitis associated with rupture. Complete surgical resection is the goal, but must be weighed against the risk for injury to nearby vital structures. Hydrocephalus should be managed promptly, and patients should be monitored for it closely in the perioperative period. Even though the recurrence rate with subtotal resection is extremely rare, follow up should be done routinely.
Highlights
Dermoid tumors are benign congenital cystic lesions that usually present with local mass effect
The present paper reports a case of a 47‐year‐old female with a traumatic intracranial dermoid cyst rupture after minor head trauma that was managed surgically with a gross total resection
Traumatic rupture of an intracranial dermoid cyst is an exceedingly rare event, with only three cases reported in the literature to date.[8,12,13]
Summary
Traumatic rupture of an intracranial dermoid cyst is an extremely rare event and this is only the fourth such case reported in the literature. The rupture of cysts has been reported after head trauma.[8,12,13] The present paper reports a case of a 47‐year‐old female with a traumatic intracranial dermoid cyst rupture after minor head trauma that was managed surgically with a gross total resection. A ventricular catheter was placed and externalized to allow residual fat droplets and sebaceous material in the ventricular system a Figure 1: Noncontrast CT scan of the head shows a heterogeneous low attenuation lesion extending from the floor of the anterior cranial fossa superiorly along the falx, with diffuse scattered areas of low‐attenuation throughout the subarachnoid space and lateral ventricles. Histo‐pathologic examination of the surgical specimens showed the wall of a ruptured dermoid cyst, with the typical squamous epithelial lining, and dispersed pilosebaceous units (hair follicles and associated sebaceous glands) with some focal calcification [Figure 4]. The patient underwent placement of a right frontal ventriculo‐peritoneal shunt
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