Sendjaja Andi Nugraha, Kobayashi Hiromasa, Morishita Takashi, Abe Hiroshi, Miki Koichi, Arifin Muhammad Zafrullah, Inoue Tooru
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan; Department of Neurosurgery, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
World Neurosurg. 2018 Aug;116:305-308. doi: 10.1016/j.wneu.2018.05.169. Epub 2018 Jun 1.
Dermoid cysts are rare tumors usually seen in the midline structure of the brain but rarely arise in the petrous apex and cavernous sinus. There have been very few reports of dermoid cysts arising in the infratemporal fossa, with scarce anatomic descriptions. Here we report the case of a patient with a dermoid cyst in the left infratemporal fossa.
The patient was a 43-year-old female with complaints of nonspecific headaches. A computed tomography (CT) scan revealed a cystic lesion measuring 25 × 18 × 15 mm in the left infratemporal fossa that had expanded the foramen ovale. The same lesion was observed as a high-intensity area on T1-weighted magnetic resonance imaging (MRI) with fat saturation. Diffusion-weighted MRI showed no restriction, unlike in cases of epidermoid cysts. A left fronto-temporo-sphenoidal craniotomy with a detachment of the zygoma was performed to approach the lesion. The tumor wall was continuously attached to the dura, although the tumor itself was entirely extradural in location. The V3 branch of the trigeminal nerve was firmly attached around the tumor. The tumor was cystic, and it shrunk after the fatty yellowish contents were suctioned. Complete resection was achieved without complications. A pathological analysis enabled the diagnosis of a dermoid cyst. No tumor recurrences or associated complications were observed at the 1-year follow-up.
Dermoid cysts in the infratemporal fossa are extremely rare. However, tumor resections can be performed safely and efficaciously using anatomically detailed preoperative planning.
皮样囊肿是罕见肿瘤，通常见于脑中线结构，但很少发生于岩尖和海绵窦。颞下窝发生皮样囊肿的报道极少，且解剖学描述匮乏。在此，我们报告一例左侧颞下窝皮样囊肿患者的病例。
患者为一名43岁女性，主诉非特异性头痛。计算机断层扫描（CT）显示左侧颞下窝有一个大小为25×18×15 mm的囊性病变，该病变使卵圆孔扩大。在脂肪抑制的T1加权磁共振成像（MRI）上，同一病变表现为高信号区。与表皮样囊肿病例不同，扩散加权MRI显示无受限情况。采用左侧额颞蝶开颅术并分离颧骨以接近病变。尽管肿瘤本身完全位于硬膜外，但肿瘤壁与硬膜持续相连。三叉神经V3分支牢固附着于肿瘤周围。肿瘤为囊性，抽吸淡黄色脂肪样内容物后缩小。实现了完整切除，无并发症发生。病理分析确诊为皮样囊肿。1年随访时未观察到肿瘤复发或相关并发症。
颞下窝皮样囊肿极为罕见。然而，通过详细的术前解剖学规划，可安全有效地进行肿瘤切除。
