Rupture of intracranial dermoid cyst with disseminated lipid droplets

• Published in: Revue neurologique Vol. 166; no. 4; pp. 451 - 457
• Main Authors: Jacquin, A, Béjot, Y, Hervieu, M, Biotti, D, Caillier, M, Ricolfi, F C, Moreau, T, Giroud, M
• Format: Journal Article
• Language: French
• Published: France 01-04-2010
• Subjects: Adult; Brain - pathology; Brain Neoplasms - metabolism; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Dermoid Cyst - metabolism; Dermoid Cyst - pathology; Dermoid Cyst - surgery; Headache - etiology; Humans; Lipid Metabolism - physiology; Magnetic Resonance Imaging; Male; Rupture; Young Adult
• ISSN: 0035-3787
• DOI: 10.1016/j.neurol.2009.09.003

Dermoid cysts are rare slow-growing benign tumors of the central nervous system generally diagnosed in the third to fifth decade. They are formed from inclusion of ectodermal elements during neural tube closure, and are mostly located along the cranial or spinal midline axis. They cause many non specific symptoms such as headache and seizures, and may spontaneously rupture spreading fatty droplets into the ventricles and subarachnoid spaces. Rupture of dermoid cysts causes sequelae which may vary from no symptoms to death. In general, subtotal surgical removal is required for ruptured dermoid cysts.
We report two cases of ruptured intracranial dermoid tumor with non-specific clinical presentations. The first rupture was asymptomatic and discovered on brain magnetic resonance imaging (MRI) performed for other purposes. The second case was identified on brain imaging performed because of daily headache. These dermoid cysts were not surgically treated. Surveillance was advised because of the spontaneously favourable outcome observed in both cases.
Surgical removal is not the only treatment of ruptured dermoid cyst. Monitoring with brain MRI can be sufficient if the rupture has no severe clinical impact.