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Ruptured pediatric cerebellopontine angle epidermoid cyst: a case report detailing radiographic evolution and
Zhe Guan1, Todd Hollon2, J Nicole Bentley2
1University of Michigan Medical School; and.
Insights
Ruptured epidermoid cysts (ECs) in children can cause brainstem swelling. This case shows how imaging reveals EC changes after rupture, with surgical removal resolving symptoms and edema.
Area of Science:
- Pediatric Neurosurgery
- Neuroradiology
- Neuropathology
Background:
- Epidermoid cysts (ECs) are rare pediatric tumors typically found in the cerebellopontine angle.
- Cyst rupture is a known complication, but its radiographic progression and associated brainstem edema are not well-documented.
Purpose of the Study:
- To describe the radiographic evolution of a pediatric cerebellopontine angle epidermoid cyst after rupture.
- To document the clinical course and treatment of resultant brainstem edema.
Main Methods:
- Case presentation of a 13-year-old female with a cerebellopontine angle EC.
- Magnetic resonance imaging (MRI) to assess cyst characteristics, mass effect, and brainstem edema.
- Surgical resection of the epidermoid cyst.
Main Results:
- Initial MRI showed a cerebellopontine angle EC with significant pericystic brainstem edema and fourth ventricle effacement.
- Follow-up imaging after symptom exacerbation revealed cyst enlargement and rim enhancement.
- Surgical resection of the EC led to complete resolution of symptoms and brainstem edema.
Conclusions:
- This case highlights the radiographic changes associated with epidermoid cyst rupture in the pediatric brainstem.
- Early recognition and surgical intervention are crucial for managing symptomatic epidermoid cysts and associated edema.
Abstract:
Epidermoid cysts (ECs) are uncommon pediatric tumors that often occur in the cerebellopontine angle. Although cyst rupture is a recognized complication, the radiographic evolution of an EC following rupture and the resultant parenchymal brainstem edema have not been reported. The authors present the case of a 13-year-old female with a newly diagnosed cerebellopontine angle EC who presented with worsening headaches, photophobia, and emesis. Magnetic resonance imaging demonstrated significant pericystic brainstem edema and mass effect with effacement of the fourth ventricle. Refractory symptoms prompted repeat imaging, revealing cyst enlargement and dense rim enhancement. Resection of the EC resolved both her symptoms and the brainstem edema. This case documents the radiographic evolution of EC rupture and subsequent clinical course.
