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Child dermoid cyst mimicking a craniopharyngioma: the benefit of MRI T2-weighted diffusion sequence
Aymeric Amelot1, Alin Borha2, Raphael Calmon3
1Department of Pediatric Neurosurgery, Necker Hospital, Université René Descartes, Paris Cité Sorbonne, Paris, France. aymmed@hotmail.fr.
Insights
Pediatric brain dermoid cysts are rare and can mimic craniopharyngioma. This case highlights a suprasellar dermoid cyst diagnosed via MRI and CT, emphasizing imaging challenges in pediatric neurosurgery.
Area of Science:
- Neurosurgery
- Pediatric Neurology
- Radiology
Background:
- Brain dermoid cysts are rare benign lesions with potential for severe complications.
- Asymptomatic pediatric dermoid cysts are exceptionally uncommon.
- Distinguishing dermoid cysts from craniopharyngioma can be challenging despite advanced imaging.
Background:
Brain dermoid cysts are very rare lesions. Although benign, these cysts may be associated with devastating complications due to mass effect or meningitis. The discovery of completely asymptomatic dermoid cysts in the pediatric population is exceedingly rare. Despite the advances in imaging modalities, it sometimes remains difficult to exclude the differential diagnosis of craniopharyngioma.
Case Report:
We describe a 12-year-old boy addressed for suspicion of craniopharyngioma diagnosed by decreased visual acuity, bitemporal hemianopia and a CT scan showing a large hypodense suprasellar lesion with intralesional calcifications. Despite the unusual localization and size of this lesion, the absence of dermal sinus commonly found, and before visualizing a hyperintense mass on MRI-diffusion, the diagnosis of craniopharyngioma was ruled out in favor of a dermoid cyst. Radical excision was performed.
Conclusion:
In the suprasellar area, craniopharyngioma and dermoid cyst may have very similar radiological aspects: low density masses on CT scan and a hyperintense signal on T1-weighted MRI sequences with a variable signal on T2-weighted sequences. Hitherto, only two cases in literature have described suprasellar dermoid cyst. Their initial diagnosis was facilitated by the presence of a dermal sinus.
