What factors contribute to the symptoms of patients with intracranial dermoid cysts?
Patients may present vague symptoms, with headache being a prominent feature. Symptoms depend on locality, mass effects with compression of adjacent structures or complications due to rupture.
Can dermoid cysts demonstrate high density on CT?
Rarely, dermoid cysts can demonstrate very high density on CT, referred to dense or white dermoids. These lesions tend to occur almost exclusively in the cerebellum and are thought to have high protein concentrations. These lesions will be T1 hyperintense because of the protein content but extremely hypointense on T2-weighted imaging.
How is the diagnosis on CT or MRI of the rupture of the intracranial dermoid cysts made?
The presence of fat droplets throughout the subarachnoid space or in the ventricular system on the CT scan or MRI is the hallmark in confirming the diagnosis of rupture dermoid cysts.
Which is the preferred treatment for the dermoid cysts?
The preferred treatment is the surgical removal of contents as well as the underlying cyst wall. Although recurrence after subtotal resection is rare, close follow up is recommended.
Magnetic resonance imaging (MRI) shows a large mass in the left parasellar region, relating to the middle cerebral artery anteriorly and causing extrinsic compression on the left mesencephalon.
The lesion shows heterogeneous hyperintense signal on T1 and T2 weighted sequences, with loss of signal following fat suppression sequences.
Droplets of T1 hyperintense material are present throughout the subarachnoid space and ventricular system.