Delayed Ischemic Deficit after Resection of a Large Intracranial Dermoid: Case Report and Review of the Literature

Author:

Ecker Robert D.1,Atkinson John L.1,Nichols Douglas A.1

Affiliation:

1. Department of Neurologic Surgery and Division of Neuroradiology, Mayo Clinic and Foundation, Rochester, Minnesota

Abstract

Abstract OBJECTIVE AND IMPORTANCE A unique case of delayed ischemic deficit after resection of a large intracranial dermoid is presented. CLINICAL PRESENTATION A 23-year-old woman, 36 hours after the uneventful gross total resection of a large intracranial dermoid cyst, slowly developed a progressive mixed aphasia and right hemiparesis. Magnetic resonance imaging and magnetic resonance angiography revealed small infarcts of the left putamen and temporal-occipital junction and a vasospastic tapering of the left M1 segment. INTERVENTION Angiography confirmed severe vasospastic tapering of the left M1 and M2 segments. Endovascular treatment successfully restored flow in the left superior division. However, the initial attempt at low-pressure dilation of the inferior division led to vessel rupture. Seven months after reoperation for emergent trapping of the M1 segment, the patient made an excellent recovery, with only mild right-hand incoordination. CONCLUSION Ruptured dermoid cysts are a risk for early and delayed cerebral ischemia, and endovascular treatment of dermoid-encased vessels may carry a higher risk for rupture.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Neurology (clinical),Surgery

Reference16 articles.

1. Multiple complications from an intracranial epidermoid cyst: Case report and literature review;Abramson;Neurosurgery,1989

2. Intracranial epidermoid and dermoid cysts: Results of microneurosurgery;Bucciero;Minerva Chir,1997

3. Supratentorial dermoid cysts: Presentation and management of five cases;Bucciero;J Neurosurg Sci,1995

4. Temporoparietal dermoid cysts with intracranial extension;Currarino;AJNR Am J Neuroradiol,1988

5. Case report: Transient cerebral ischemia as a manifestation of ruptured intracranial dermoid cyst;Ford;J Comput Assist Tomogr,1981

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