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Intracranial complications of midline nasal dermoid cysts
Dries Opsomer1, Toon Allaeys1, Ann-Sofie Alderweireldt2
1a Department of Plastic Surgery , Gent University , Gent , Belgium.
Insights
Infected nasal dermoid cysts with intracranial extension can cause severe brain abscesses in children. Early diagnosis and surgical excision are crucial to prevent life-threatening complications.
Area of Science:
- Pediatric Surgery
- Pediatric Neurosurgery
- Developmental Biology
Background:
- Nasal dermoid cysts are congenital tumors arising from embryologic malformations.
- Intracranial extension of nasal dermoid cysts poses a risk for serious complications.
- Infection of these cysts can lead to meningitis and brain abscesses.
Observation:
- A 1.5-year-old girl presented with fever and seizures due to an infected nasal dermoid cyst.
- Imaging revealed a subcutaneous mass with associated encephalitis and brain abscess.
- The child required intensive care and neurosurgical intervention.
Findings:
- Infected nasal dermoid cysts with intracranial extension can result in severe neurological deficits.
- Prompt medical and surgical management is essential for favorable outcomes.
- Despite treatment, irreversible brain damage is a concern in young children.
Implications:
- Healthcare providers must maintain a high index of suspicion for nasal midline dermoid cysts.
- Comprehensive work-up including imaging (ultrasound, CT, MRI) is vital.
- Complete surgical excision is the recommended treatment to prevent recurrence and complications.
Background:
Nasal dermoid cysts are common tumors in children. Due to anomalies in embryologic development of the nasal complex, sometimes an intracranial extension exists. When these cysts become infected they can lead to meningitis, brain abscess and death.
Methods:
We report the case of a 1.5-year-old girl admitted to the paediatric intensive care unit after infection of a nasal dermoid cyst.
Results:
The infant had a spiking fever and epileptic seizures. She was stabilized, intubated and a CT scan showed a subcutaneous mass with an adjacent zone of encephalitis and brain abscess formation. Neurosurgical interventions were necessary to lower intracranial pressure and control infectious spread. After a hospital stay of 69 days the child could be discharged. Due to her young age, irreversible brain damage is expected.
Conclusion:
Nasal midline dermoid cysts are considered benign swellings. When an intracranial extension exists, infection can lead to deleterious complications. It is important for health care practitioners to be aware of this imminent risk. Suspicion of a nasal midline dermoid cyst should prompt a careful clinical work-up with an ultrasound followed by CT or MRI imaging. The treatment is complete excision to avoid disastrous complications and recurrences.
