Dermoid cysts of the cavernous sinus: a systematic review

Dermoid cysts in the cavernous sinus (CSDCs) are scarce, and their key features are largely unknown. A systematic review was conducted following PRISMA guidelines up to March 2025, using PubMed and Google Scholar databases. Actual CSDCs with sufficient available information were selected. An additional case from the authors' series was included. Data collected included age, gender, CSDC size, symptoms, duration from symptom onset, physical findings, radiological features, treatment, and outcomes. Thirty-eight cases were analyzed (37 from databases plus the author's case). Headache and diplopia were the most common presenting symptoms. The most frequent signs were trigeminal, oculomotor, and abducens palsies. The average CSDC size was 42.6 mm (SD 20.3). Cyst shapes included oval (n = 21/37, 56.7%), circular (n = 6/37, 16.2%), and dumbbell (n = 10/37, 27%). Extracavernous growth was observed in 12 of 37 cases (32.4%), mainly among dumbbell-shaped cysts (p < 0.001). CSDC rupture was seen in 13 of 38 cases (34.2%), with associations to hydrocephalus (p < 0.001), larger cyst size, epilepsy, and aseptic meningitis (p < 0.05). Hydrocephalus (n = 5/38; 13%) correlated with cyst rupture and larger size (p < 0.001). Most CSDCs (30/38, 79%) were in the cavernous sinus lateral-interdural compartment, while 8 cysts (21%) were within the venous intracavernous space. Medial ICA displacement was only seen in interdural CSDCs (p < 0.001). CSDC removal was attempted in 33 of 38 cases (86.8%). Complete removal was achieved in 21 of 29 cases (72.4%), near-total in 6 (20.7%), and partial in 2 (6.9%). All clinical outcomes were satisfactory (median mRS 0, IQR 0-1). Transient postoperative abducens palsy was associated with endoscopic-endonasal approaches (p < 0.05). CSDCs are rare lesions that usually present with headache and cranial nerve palsies. They are mostly interdural, located at the CS lateral wall. Surgery remains the primary treatment for CSDCs and should be tailored to the cyst's location (interdural versus purely intracavernous).