Kosuge Yasushi, Onodera Hidetaka, Sase Taigen, Uchida Masashi, Takasuna Hiroshi, Ito Hidemichi, Oshio Kotaro, Tanaka Yuichiro
Department of Neurosurgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae, Kawasaki, Japan.
J Med Case Rep. 2016 Aug 12;10(1):224. doi: 10.1186/s13256-016-1007-3.
Dermoid cysts are non-neoplastic tumors that arise from defects in the separation of the neuroectoderm. Cyst rupture rarely occurs spontaneously and the most common symptom is headache, followed by seizure. Although many cases of ruptured dermoid cysts present with symptoms, reports of cases that are asymptomatic, or where symptoms disappear, are rare.
We report the case of a 66-year-old Asian man with a history of sudden onset headache who was found to have high amounts of fat material in the subarachnoid space and a fat suppression mass in the left cavernous sinus. He underwent oral steroid therapy. Five days after starting medication his headache symptoms disappeared. Routine neurological imaging was then performed without surgical procedure. Magnetic resonance imaging revealed evidence of the remains of a static lesion 6 months after his first visit. He has remained headache free for 10 months since the initial event.
Although cases of ruptured dermoid cysts presenting with consistent symptoms have been commonly reported, until now there were few reports on asymptomatic cases or cases where symptoms disappeared. We believe that surgical intervention is unnecessary for ruptured dermoid cysts with minimal symptoms.
皮样囊肿是起源于神经外胚层分离缺陷的非肿瘤性肿瘤。囊肿破裂很少自发发生，最常见的症状是头痛，其次是癫痫发作。尽管许多破裂的皮样囊肿病例都有症状表现，但无症状或症状消失的病例报告却很少见。
我们报告了一例66岁的亚洲男性，有突发头痛病史，发现其蛛网膜下腔有大量脂肪物质，左侧海绵窦有脂肪抑制肿块。他接受了口服类固醇治疗。用药五天后，他的头痛症状消失。然后在未进行手术的情况下进行了常规神经影像学检查。磁共振成像显示首次就诊6个月后仍有静态病变残留的迹象。自最初发病以来，他已10个月没有头痛症状。
尽管已普遍报道了有持续症状的破裂皮样囊肿病例，但迄今为止，关于无症状病例或症状消失病例的报道很少。我们认为，对于症状轻微的破裂皮样囊肿，无需进行手术干预。
