An infected intracranial dermoid cyst at the region of torcular herophili: A case report.

Abstract

Background: 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.

Case description: 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.

Conclusion: 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.