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Intracranial dermoid cyst: A Case Report

AUTHOR: CONSTANTIN-IONUȚ COROAMĂ

CO-AUTHORS: DAMIANA-MARIA VULTURAR; IONA HRAPȘA

COORDINATOR: FLORIAN IOAN-ALEXANDRU

INTRODUCTION:

Intracranial dermoid cysts represents an uncommon group of benign tumours evolving from the
ectodermal layer in the in-utero period. The cyst has a slowly progression and contains squamous
epithelium with possible adnexal structures (hair follicles, sebaceous or apocrine gland). The location are
more frequant in the supratentorial compartment, the symptomatology being given by the compression
on the different structures. The treatment is surgical with low rates of recurrence.

CASE PRESENTATION:

A 40 years old male patient, without personal or familiar pathological history, presented in the
Neurosurgery Clinic for bifrontal headache and vertigo. The symptomatology begun suddenly 4 months
ago, without amelioration after conservative treatment. The patient was hospitalized for investigations
and specialized treatment. The neurological examination revealed a temporo-spatial oriented patient
(Glasgow scale = 15). There were observed subtle phonation impairments, a sustained headache
syndrome and a vertigo syndrome. The patient didn’t present hyper-intracranial-pressure syndrome,
cranial nerves impairments or others signs of neurological deficit. Romberg test was negative and the
osteo-tendinous reflexes were unmodified too. The gait was normal. Head MRI revealed a multilocular,
apparently well-delimitated cystic tumour at the level of the fourth ventricle. The tumour seemed to be
in contact (amprentarea?) with the floor of the fourth ventricle and the pontine-medulla junction. The
suspicion of a fistulous trajectory at occipital and sub-occipital level was aroused. The surgery was
carried out and a complete macroscopically resection of the tumour was possible. After surgery, the
evolution was favourable, with a subtle left facial paresis that remitted spontaneously. Post-operative
CT showed no signs of remaining tumoral tissue.

CONCLUSION:

Intracranial dermoid cyst has a slowly progression. The more frequant location is in the supratentorial
compartment, but infratentorial localisation can be possible. Surgery is elective with a low rate of
reccurence.

KEYWORDS: Intracranial dermoid cysts, infratentorial, minimal symptomatology