Behind the Curtain: A Pediatric Dermoid Tumor Masquerading as Craniopharyngioma

Dermoid cysts are rare, benign congenital tumors arising from ectodermal remnants that become trapped during neural tube closure. They frequently occur in midline structures such as the sellar region, where proximity to critical neurovascular structures creates diagnostic and surgical challenges. Craniopharyngiomas, in contrast, are benign epithelial tumors originating from Rathke's pouch remnants, and patients often present with visual deficits, panhypopituitarism, and hydrocephalus. We report the case of a 13-year-old female patient with progressive vision loss whose initial imaging suggested a craniopharyngioma but whose definitive pathology revealed a dermoid cyst. The patient presented with superior temporal quadrantanopia in the right eye and temporal hemianopia in the left eye. Magnetic resonance imaging (MRI) demonstrated a lesion in the sellar region extending into the suprasellar space. Surgical resection was performed through a right frontotemporal craniotomy, and complete resection was achieved. Although the clinical and radiological features suggested a craniopharyngioma, the lesion proved to be an atypical dermoid cyst. The patient remained neurologically stable postoperatively, with persistent visual impairment attributable to irreversible damage caused by tumor compression. Dermoid cysts in the sellar region may mimic craniopharyngiomas. Accurate diagnosis and careful surgical planning are essential given the proximity of these lesions to critical neurovascular structures. This case highlights the diagnostic overlap between dermoid cysts and adamantinomatous craniopharyngiomas in the pediatric population and the importance of establishing the correct diagnosis before surgery.