Management of a rare case of intraventricular ruptured dermoid cyst and chemical meningitis

Intraventricular dermoid cyst are very rare benign tumour. Due to benign nature, it may go un-noticed for years and might present with sudden rupture. Ruptured cyst can cause chemical meningitis, hydrocephalus, seizures etc. Due to lack of data, there are no defined guidelines about its management....

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Published in:British journal of neurosurgery 2023-08, Vol.37 (4), p.630-633
Main Authors: Bishnoi, Ishu, Bishnoi, Sheikhoo, Gahlawat, Nisha, Bhardwaj, Lalit, Duggal, Geetika, Singal, Gopal, Singh, Pardaman
Format: Article
Language:English
Subjects:
Cysts
Dermoid Cyst - complications
Dermoid Cyst - diagnostic imaging
Dermoid Cyst - surgery
Humans
Hydrocephalus
Hydrocephalus - surgery
Magnetic Resonance Imaging
Male
Meningitis
Meningitis - complications
Meningitis - diagnostic imaging
Meningitis - surgery
Rupture - surgery
Rupture, Spontaneous - surgery
Seizures - etiology
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Summary:Intraventricular dermoid cyst are very rare benign tumour. Due to benign nature, it may go un-noticed for years and might present with sudden rupture. Ruptured cyst can cause chemical meningitis, hydrocephalus, seizures etc. Due to lack of data, there are no defined guidelines about its management. We are reporting an interesting case of ruptured intraventricular dermoid cyst and chemical meningitis, who was managed successfully and will review the literature. A 48 years male patient was brought with complaint of sudden mental deterioration, irritability, headache, vomiting for 3 days. He had history of seizures for 1 year. On examination, his higher mental functions were deteriorated, had neck rigidity and left lower limb weakness. CT/MRI brain confirmed diagnosis of right frontal horn ruptured dermoid cyst with scattered fat droplets, hydrocephalus and ventriculitis. Excision of cyst was done via right trans-sulcal (superior frontal sulcus) approach. Patient recovered well. Intraventricular dermoid cyst are a rare benign lesion. Due to potential of rupture, it must be surgically treated. Steroids should be used to treat chemical meningitis. Various individual case reports have shown good outcome after surgical management. We recommend early surgery, thorough ventricular wash with ringer lactate, post-operative extraventricular drain and steroid cover to manage ruptured cyst and chemical meningitis.
ISSN:0268-8697
1360-046X
DOI:10.1080/02688697.2018.1530728