Hong Sukwoo, Maruyama Keisuke, Hatanaka Ryo, Noguchi Akio, Shimoyamada Hiroaki, Nagane Motoo, Shiokawa Yoshiaki
Department of Neurosurgery, Kyorin University Hospital, Mitaka, Tokyo, Japan.
Department of Pathology, Kyorin University Hospital, Mitaka, Tokyo, Japan.
Surg Neurol Int. 2020 Dec 11;11:429. doi: 10.25259/SNI_504_2020. eCollection 2020.
Non-midline supratentorial dermoid cyst with dermal sinus tract has been rarely reported especially in adults. We recently experienced a noteworthy patient with frontotemporal dermoid cyst with incomplete dermal sinus tract.
A 43-year-old female presented with recurrent subcutaneous mass in the left superolateral orbital region. She had a history of active bronchial asthma, which precluded her from contrast-enhanced imaging studies. Plain imaging studies showed a subcutaneous mass which was continuous with an intrasylvian fissure mass by a tract in the sphenoid ridge and the lesser wing of the sphenoid bone. Frontotemporal craniotomy was performed to reset the mass and the tract. Intraoperative finding showed no intradural tumor components. Extradural component was carefully removed focusing attention on the frontal branch of the facial nerve. The pathology was consistent with dermoid cyst and dermal sinus tract. Postoperatively, she had mild facial palsy of the corrugator supercilii (House and Brackmann Grade II). She was discharged home with modified Rankin scale 1.
Dermoid cyst needs to be included in the differential diagnosis of adult-onset subcutaneous mass in the frontotemporal regions. After thorough imaging studies for the presence and extent of the sinus tract, the symptomatic lesion should be excised completely once and for all.
非中线幕上皮样囊肿合并皮样窦道鲜有报道，尤其是在成人中。我们最近遇到了一位值得关注的患者，患有额颞部皮样囊肿合并不完全皮样窦道。
一名43岁女性，左眶外上区域反复出现皮下肿块。她有活动性支气管哮喘病史，这使得她无法进行增强成像检查。平扫影像学检查显示一个皮下肿块，通过蝶骨嵴和蝶骨小翼的一个管道与大脑外侧裂内的肿块相连。行额颞部开颅手术以复位肿块和管道。术中发现无硬脑膜内肿瘤成分。硬膜外成分被小心切除，重点关注面神经额支。病理结果符合皮样囊肿和皮样窦道。术后，她出现了皱眉肌轻度面瘫（House和Brackmann分级II级）。她出院时改良Rankin量表评分为1分。
皮样囊肿需要纳入成人额颞部皮下肿块的鉴别诊断。在对窦道的存在和范围进行全面的影像学检查后，有症状的病变应一次性彻底切除。
