Ruptured intracranial dermoid cysts: A retrospective institutional review

Intracranial dermoids (ID) are relatively uncommon. They are usually located in the midline or posterior fossa, and present in the first three decades of life. Rupture of IDs are a rare occurrence, and can present with diverse clinical features. They have a characteristic appearance on Computerized Tomography (CT) and Magnetic-Resonance-Imaging (MRI). Here we retrospectively review the clinical features, radiology, treatment and outcomes of ruptured IDs managed in our institute. We did a retrospective review of all the IDs from 2011 to 2017 that presented to us with rupture, or that were diagnosed to have ruptured based on imaging characteristics. Nine patients qualified for our study. The data of all 9 patients was analyzed retrospectively and their demographic details, clinical variations, and radiological features were studied and analyzed. Mode of management and outcome was assessed. Mean age of the patients was 32.1 years (SD 7.65) with male-female ratio of 7:2. Patients presented with either headache or seizures in the majority. Two patients had hydrocephalus requiring shunts. Despite their varied location and clinical features, all lesions showed similar and characteristic radiological features-namely, fat droplets in subarachnoid spaces, hypo-intensity on Susceptibility-Weighted-Imaging (SWI) with chemical shift artifact. Treatment of patients varied from medical management in 4, to cerebrospinal fluid (CSF) diversion in 2 and surgery for the lesion in 3 cases. Ruptured IDs present with a wide array of clinical features. Imaging characteristics are fairly distinct and consistent, which aids in diagnosis. Decision for mode of management has to be decided based on case-by-case basis.