Pahari Soumya, Bhandari Paawan Bahadur, Sharma Muna, Baniya Purushottam, Devkota Deekshya, Jha Rahul, Subedi Prarthana
Department of Neurosurgery, Shree Birendra Hospital, Kathmandu, Nepal.
Department of Medicine, Nepalese Army Institute of Health Sciences, College of Medicine, Kathmandu, Nepal.
Surg Neurol Int. 2024 Nov 15;15:412. doi: 10.25259/SNI_490_2024. eCollection 2024.
Dermoid cysts result from embryonic fusion anomalies, with intracranial dermoid cysts being rare (0.1-0.7% of intracranial tumors). Often asymptomatic, they can manifest as midline swelling, headaches, seizures, or cerebral ischemia. Recognition and management are crucial for mitigating complications and ensuring favorable patient outcomes.
A 14-year-old girl presented with swelling at the occiput for 3 months. Initial imaging was suggestive of an extra-dural abscess in the occipital region with surrounding bone erosion. An infectious workup, including tests for tuberculosis, was non-contributory. A suboccipital craniectomy was done. On lifting, the bone flap, thick, purulent, and sebaceous contents with hair were spotted, which was adherent to the inner table of the skull and the dura overlying the torcular herophili, suggesting an infected dermoid cyst. A near-total excision was done, and culture-directed antibiotics were given. Postoperatively, the child made a complete recovery.
The diagnosis of a dermoid cyst must be kept in mind, and it should be considered in the differential diagnosis of midline posterior fossa lesions. The risk of postoperative recurrence from incomplete excision should be weighed against the risk of injuring the venous sinuses during the extensive resection of dermoid cysts adherent to the torcular region.
皮样囊肿由胚胎融合异常引起，颅内皮样囊肿较为罕见（占颅内肿瘤的0.1 - 0.7%）。通常无症状，可表现为中线肿胀、头痛、癫痫发作或脑缺血。识别和处理对于减轻并发症和确保患者良好预后至关重要。
一名14岁女孩枕部肿胀3个月。初始影像学检查提示枕部硬膜外脓肿伴周围骨质侵蚀。包括结核检测在内的感染性检查无阳性发现。行枕下颅骨切除术。掀起骨瓣时，发现有厚的脓性和含毛发的皮脂腺样内容物，其附着于颅骨内板及横窦沟上方的硬脑膜，提示为感染性皮样囊肿。行次全切除，并给予针对性培养的抗生素。术后，患儿完全康复。
必须考虑皮样囊肿的诊断，在中线后颅窝病变的鉴别诊断中应予以考虑。对于附着于横窦区的皮样囊肿进行广泛切除时，应权衡不完全切除导致术后复发的风险与损伤静脉窦的风险。
