Kikuchi Zensho, Takemura Sunao, Kuge Atsushi, Sato Shinya, Kayama Takamasa
Department of Neurosurgery,Yamagata University Faculty of Medicine, Japan.
No Shinkei Geka. 2010 May;38(5):455-62.
We report a rare case of spontaneous rupture of an asymptomatic, intracranial dermoid cyst. A 64-year-old man complained of transient dizziness. MRI incidentally disclosed a 20-mm-diameter cystic lesion in the left cerebellopontine angle. Since the cyst was asymptomatic, follow-up MRIs were performed. One year later, sudden headache and left oculomotor palsy occurred. MRI showed niveau formation within the cyst and scattered fat droplets within the cerebrospinal fluid space, which indicated a spontaneous rupture of the dermoid cyst. Since hydrocephalus on MRI and gait disturbance appeared 2 months later, the tumor was resected, and a ventriculoperitoneal shunt was inserted. The patient's symptoms disappeared, and there were no postoperative neurological deficits. The pathological diagnosis was dermoid cyst. Only 48 cases of spontaneous rupture of a dermoid cyst have been reported. All were symptomatic, and MRI showed a large cyst. Of these cases, none was detected incidentally. Therefore, this is the first case report of an incidentally found dermoid cyst that ruptured spontaneously. Although asymptomatic, small dermoid cysts are usually followed up by MRI without surgical intervention. The possibility of spontaneous rupture, which may give rise to hydrocephalus, as in this case, should always be kept in mind.
我们报告一例罕见的无症状颅内皮样囊肿自发性破裂病例。一名64岁男性主诉短暂头晕。MRI偶然发现左侧桥小脑角有一个直径20毫米的囊性病变。由于囊肿无症状，遂进行了随访MRI检查。一年后，患者突发头痛和左侧动眼神经麻痹。MRI显示囊肿内有液平形成，脑脊液间隙内有散在脂肪滴，提示皮样囊肿自发性破裂。2个月后，MRI显示脑积水且出现步态障碍，遂切除肿瘤并置入脑室腹腔分流管。患者症状消失，术后无神经功能缺损。病理诊断为皮样囊肿。此前仅报道过48例皮样囊肿自发性破裂病例。所有病例均有症状，且MRI显示囊肿较大。在这些病例中，无一例是偶然发现的。因此，这是首例偶然发现的皮样囊肿自发性破裂的病例报告。虽然无症状的小皮样囊肿通常通过MRI随访而无需手术干预，但应始终牢记其可能发生自发性破裂并导致脑积水的情况，就像本病例一样。
