Department of Neurosurgery, Mount Sinai School of Medicine, Annenberg Building 8-28, 1 Gustave L. Levy Place, Box 1136, New York, NY 10029, USA.
Department of Neurosurgery, Mount Sinai School of Medicine, Annenberg Building 8-28, 1 Gustave L. Levy Place, Box 1136, New York, NY 10029, USA.
J Clin Neurosci. 2014 Jan;21(1):159-61. doi: 10.1016/j.jocn.2013.02.005. Epub 2013 Jul 27.
A 51-year-old man with several months of headache and progressive visual decline was found to have bilateral optic disc pallor with significant impairment of visual acuity. Despite a thorough ophthalmologic evaluation, the cause of visual loss could not be elucidated. MRI of the brain revealed a lesion in the left anterior Sylvian fissure as well as disseminated foci of subarachnoid fat consistent with a diagnosis of a ruptured dermoid cyst. The decision for open surgical resection was chosen to minimize the risk of cyst re-rupture and further visual or neurologic decline. The diagnosis of dermoid cyst was confirmed at the time of surgery. Vasospasm-induced ischemia of the optic nerves, optic chiasm or bilateral optic tracts secondary to the inflammatory reaction following cyst rupture is the most likely mechanism of visual loss in this patient. To the authors' knowledge, this report represents the first reported case of visual loss secondary to rupture of an intracranial dermoid cyst not related to mass effect of the tumor on the optic apparatus, visual pathways or visual cortex.
一位 51 岁男性，头痛数月并逐渐出现视力下降，检查发现双侧视盘苍白，视力明显受损。尽管进行了全面的眼科评估，但仍未能明确视力丧失的原因。脑部 MRI 显示左侧额颞叶脑裂中有病变，以及蛛网膜下腔脂肪散布的病灶，符合破裂的皮样囊肿的诊断。选择开颅手术切除是为了降低囊肿再次破裂和进一步视力或神经功能下降的风险。手术时证实了皮样囊肿的诊断。囊肿破裂后炎症反应引起的视神经、视交叉或双侧视束血管痉挛性缺血是导致该患者视力丧失的最可能机制。据作者所知，这是首例报道的颅内皮样囊肿破裂导致的视力丧失病例，与肿瘤对视器、视觉通路或视皮质的压迫效应无关。
