[Case report: spontaneous rupture of an asymptomatic intracranial dermoid]

We report a rare case of spontaneous rupture of an asymptomatic, intracranial dermoid cyst. A 64-year-old man complained of transient dizziness. MRI incidentally disclosed a 20-mm-diameter cystic lesion in the left cerebellopontine angle. Since the cyst was asymptomatic, follow-up MRIs were performed. One year later, sudden headache and left oculomotor palsy occurred. MRI showed niveau formation within the cyst and scattered fat droplets within the cerebrospinal fluid space, which indicated a spontaneous rupture of the dermoid cyst. Since hydrocephalus on MRI and gait disturbance appeared 2 months later, the tumor was resected, and a ventriculoperitoneal shunt was inserted. The patient's symptoms disappeared, and there were no postoperative neurological deficits. The pathological diagnosis was dermoid cyst. Only 48 cases of spontaneous rupture of a dermoid cyst have been reported. All were symptomatic, and MRI showed a large cyst. Of these cases, none was detected incidentally. Therefore, this is the first case report of an incidentally found dermoid cyst that ruptured spontaneously. Although asymptomatic, small dermoid cysts are usually followed up by MRI without surgical intervention. The possibility of spontaneous rupture, which may give rise to hydrocephalus, as in this case, should always be kept in mind.