Intraaxial dermoid cyst of the medulla

Case report

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Intracranial dermoid cysts are rare congenital lesions that typically occur in the cisternal spaces. However, exceptionally rare cases of intraaxial involvement have been reported, with only 8 cases having been described in the literature. The authors report the first case of an intraaxial dermoid cyst located in the medulla and the first occurrence in an elderly patient. They also review the literature of the existing intraparenchymal cases and provide treatment guidelines. A 66-year-old man presented with slowly progressive dysphagia, left lower-extremity numbness, nausea, and hyperhidrosis. Neurological examination revealed decreased pinprick sensation of the left side of his face and body, and decreased vibratory sensation in his left lower extremity. Additionally, he had an unusual extraocular movement in which abduction of the eye resulted in closure of the contralateral eye. Magnetic resonance imaging revealed a nonenhancing cystic lesion centered in the medulla. The patient underwent a suboccipital craniotomy with laminectomy of C1–2 for excision of the cyst, with subtotal resection due to adherence of the cyst wall to the brainstem. At follow-up 7.5 years after surgery, the patient's neurological examination was stable. Magnetic resonance imaging did not reveal any progression or recurrence of the cyst. As the cyst wall is typically adherent to surrounding structures, resection is usually subtotal due to the risk of neurological deficits. As there have been no cases of progression after subtotal resection, gross-total resection is not warranted for the treatment of these lesions.

Abbreviation used in this paper:DWI = diffusion-weighted imaging.

Article Information

Address correspondence to: Cory Adamson, M.D., Ph.D., M.P.H., M.H.Sc., Division of Neurosurgery, DUMC 2624, Durham, North Carolina 27710. email: cory.adamson@duke.edu.

Please include this information when citing this paper: published online April 26, 2013; DOI: 10.3171/2013.3.JNS122430.

© AANS, except where prohibited by US copyright law.

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Figures

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    Magnetic resonance images revealing a cystic lesion within the medulla, consistent with an intraaxial dermoid/epidermoid cyst. A: Contrast-enhanced T1-weighted axial image demonstrating a homogeneously hypointense lesion. B: Axial T2-weighted image showing a homogeneously hyperintense lesion. C: Diffusion-weighted image demonstrating the lesion to be hyperintense, suggesting an epidermoid or dermoid cyst. D: Contrast-enhanced T1-weighted sagittal image demonstrating a cyst centered in the medulla.

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    Photomicrograph showing a squamous epithelial cyst with adherent keratin debris, consistent with a dermoid cyst. H & E, original magnification ×40.

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