Cerebellar abscesses secondary to occipital dermoid cyst with dermal sinus: case report.
ABSTRACT Hydrocephalus and cerebellar abscesses as the principal manifestations of posterior fossa dermoid cyst are rare. In addition, extradural dermoid cyst of the posterior fossa has been described in only 9 cases in the literature. We present an unusual case of obstructive hydrocephalus due to cerebellar abscesses induced by an adjacent extradural dermoid cyst with complete occipital dermal sinus.
A 14-month-old child presented with acute raised intracranially pressure, seizures, and meningitis. Neuroradiological studies revealed cerebellar cysts with ring enhancement associated with a contiguous occipital cyst, with compression of the adjacent cisterns and the fourth ventricle causing hydrocephalus. The diagnosis of cerebellar abscesses with congenital occipital defect was briefly entertained. The patient was treated by radical excision of the occipital cyst with hair contents, the dermal sinus, and the abscesses through a suboccipital approach, followed by systemic antibiotic therapy with a good outcome. Pathologic examination revealed a dermoid cyst.
Posterior fossa dermoid cyst should be considered in all children with occipital skin lesions, especially dermal sinus. CT scan and MRI are the methods of choice for further investigation of suspect congenital dermal lesions. Neurosurgical treatment of these malformations should be planned early to prevent the high incidence of infections such as bacterial meningitis and cerebellar abscess. Clinical presentation, diagnostic evaluation, and treatment of these rare lesions are reviewed.
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ABSTRACT: Dermal sinuses have been associated with a wide spectrum of clinical manifestations ranging from asymptomatic to drainage of purulent material from the sinus tract, inclusion tumors, meningitis, and spinal abscess. To date, there has been no documented report of brain abscess as a complication of spinal dermal sinus. Here, we report an 8-month-old girl who was presented initially with a brain abscess at early infancy but lumbar dermal sinus and associated spinal abscess were discovered afterwards. The probable mechanisms of this rare association have been discussed.Therapeutics and Clinical Risk Management 11/2008; 4(5):1143-7.
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ABSTRACT: Intracranial dermoid cysts are rare, but can cause recurrent bacterial or aseptic meningitis, abscesses or mass effect. We describe a toddler who manifested an occipital "lump" for 6 months without further evaluation. He presented with lethargy and meningitis. A posterior fossa dermoid cyst with a sinus tract was detected by imaging studies. He underwent prompt surgical excision of the cyst and the sinus, and received a prolonged course of antibiotics, because anaerobes were isolated from the contents of the cyst and blood. His postoperative course was complicated, and required the placement of a lumboperitoneal shunt. A high index of suspicion for the detection of dermoid cysts is required when a congenital midline skin lesion such as a dimple or a scalp swelling is reported. Prophylactic excision is indicated to prevent serious sequelae.Pediatric Neurology 08/2008; 39(1):63-6. · 1.42 Impact Factor
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ABSTRACT: Klippel-Feil syndrome (KFS) is characterized by specific congenital anomalies of segmentation of the cervical spine. On the other hand, dermoid tumour is a rare entity accounting for 0.04-0.7% of all intracranial tumours and the most common location is in the posterior fossa, at or near the midline. A new case with the association of KFS and the posterior fossa dermoid tumour is presented with complaints of progressive headache, occipital lump, and short neck. Plain radiography and 3D computed tomography (CT) of the craniovertebral region revealed a central occipital hole as well as fusion of the C4-7 vertebrae. CT and magnetic resonance imaging (MRI) of the brain demonstrated a well circumscribed midline cystic mass without contrast enhancement in the posterior fossa compressing the vermis and cerebellum. A suboccipital craniectomy was done and dermoid tumour with dermal sinus was removed totally after the opening of the dura mater. Pathological examination confirmed that the mass was a dermoid tumour consisting of stratified squamous epithelium, hair, keratin and sebaceous glands. Control MRI showed no evidence of recurrence and the patient was asymptomatic. The experience prompted me to review reports in the literature since 1936 of posterior fossa dermoid tumour associated with KFS. From my analysis, I highlight early diagnosis and an appropriate surgery to prevent complications such as neural compression and bacterial or aseptic meningitis through the rupture site or dermal sinus in cases of KFS associated with for dermoid tumours of the posterior fossa.Acta Neurochirurgica 03/2009; 151(3):269-76. · 1.55 Impact Factor