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A Nonoperative Approach for Neurosurgical Management of a Sylvian Fissure Dermoid Cyst

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ABSTRACT

The nonoperative management of sylvian fissure dermoid/epidermoid cysts presents a risk that is difficult to quantify. With rupture, potentially fatal complications such as chemical meningitis, hydrocephalus, fever, seizure, or meningeal irritation may occur. In this paper, we present an asymptomatic case of such a cyst with imaging evidence of prior rupture, and we review the literature for the likelihood of future complications. We use for illustration a case of a 68-year-old woman with imaging features of a sylvian fissure epithelial inclusion cyst who refused surgical intervention and review the literature for further investigation. Conservative management of our patient has not resulted in a complication in over five years, with the continued offer of surgical resection rejected by the patient. This article suggests the possibility of a safe, non-operative management of dermoid/epidermoid cysts of the sylvian fissure; however, the paucity of literature calls for larger studies yielding reliable data regarding the comparative risk of nonoperative management, including the rate of spontaneous rupture, versus the risk and complication incidence of surgical intervention.

No MeSH data available.


2014 Repeat MRIRepeat T1-weighted MRI image in 2014 showing no new evidence of significant change in appearance. 
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FIG3: 2014 Repeat MRIRepeat T1-weighted MRI image in 2014 showing no new evidence of significant change in appearance. 

Mentions: Rather, the mass appeared to be gently pushing on the brain. When these images were juxtaposed to the patient's previous MRI, it was observed that the dermoid/epidermoid cyst showed no evidence of significant structural or anatomical changes over time (Figures 2-3). However, a sole new finding was the gradient echo, a heme-sensitive axial sequence which demonstrated blooming and a drop in signal intensity throughout the main mass and within all T1-hyperintense foci located in the sulci. The signal drop suggests the presence of hemorrhagic products as it is not typically seen with oily substances often found within these cysts. No midline shift was noted; cerebral/lateral and third ventricles were consistent in size and shape with previous imaging.


A Nonoperative Approach for Neurosurgical Management of a Sylvian Fissure Dermoid Cyst
2014 Repeat MRIRepeat T1-weighted MRI image in 2014 showing no new evidence of significant change in appearance. 
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120966&req=5

FIG3: 2014 Repeat MRIRepeat T1-weighted MRI image in 2014 showing no new evidence of significant change in appearance. 
Mentions: Rather, the mass appeared to be gently pushing on the brain. When these images were juxtaposed to the patient's previous MRI, it was observed that the dermoid/epidermoid cyst showed no evidence of significant structural or anatomical changes over time (Figures 2-3). However, a sole new finding was the gradient echo, a heme-sensitive axial sequence which demonstrated blooming and a drop in signal intensity throughout the main mass and within all T1-hyperintense foci located in the sulci. The signal drop suggests the presence of hemorrhagic products as it is not typically seen with oily substances often found within these cysts. No midline shift was noted; cerebral/lateral and third ventricles were consistent in size and shape with previous imaging.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

The nonoperative management of sylvian fissure dermoid/epidermoid cysts presents a risk that is difficult to quantify. With rupture, potentially fatal complications such as chemical meningitis, hydrocephalus, fever, seizure, or meningeal irritation may occur. In this paper, we present an asymptomatic case of such a cyst with imaging evidence of prior rupture, and we review the literature for the likelihood of future complications. We use for illustration a case of a 68-year-old woman with imaging features of a sylvian fissure epithelial inclusion cyst who refused surgical intervention and review the literature for further investigation. Conservative management of our patient has not resulted in a complication in over five years, with the continued offer of surgical resection rejected by the patient. This article suggests the possibility of a safe, non-operative management of dermoid/epidermoid cysts of the sylvian fissure; however, the paucity of literature calls for larger studies yielding reliable data regarding the comparative risk of nonoperative management, including the rate of spontaneous rupture, versus the risk and complication incidence of surgical intervention.

No MeSH data available.