Ruptured intracranial dermoid cyst

Case contributed by Dr Sunil Bonela

Presentation

Presented for the evaluation of complaints of nausea, vomiting , and headache.

Patient Data

Age: 25 Years
Gender: Male

ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with Radiopaedia.org.

A relatively well defined extra-axial oval shaped heterogeneous mass lesion appearing hyperintense on T1W/T2W, hypointense on FLAIR and showing suppression on T2W fat saturation images suggesting a fat containing lesion in midline suprasellar and left parasellar region, with mass effect in the form of very minimal compression of the optic chiasm. Scattered bright hyperintense foci suggesting fat-containing droplets were disseminated throughout the subarachnoid spaces into the left Sylvian fissure and perimesencephalic cisterns.

Well defined extra-axial hypodense fat containing lesion of attenuation ranging from -90 to -100 HU in midline suprasellar and left parasellar region. Scattered fat-containing droplets were disseminated throughout the subarachnoid spaces into the left Sylvian fissure and perimesencephalic cisterns.

Case Discussion

Intracranial dermoid cysts are rare, comprising less than 0.5% of primary intracranial tumors. Intracranial dermoids are congenital epidermal inclusion cysts. Intracranial dermoid cystic tumors are rare, benign, slow growing masses. They are most often found in a sellar or parasellar location as well as the frontonasal region and frequently reside near the skull base. Intracranial dermoids can also be found in the posterior cranial fossa in midline vermis and within or in close proximity to the fourth ventricle. It can also be intraventricular within tela choroidea in lateral, 3rd, or 4th ventricles.

If ruptured subarachnoid/intraventricular spread of contents can be noted (as in this case).

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