Intracranial dermoid cyst is a benign expansive lesion typically affecting children and young adults. They become symptomatic by progressive enlargement of the cyst and spilling of its content. In such cases, recurrent aseptic meningitis is observed. When located in the suprasellar area, optic pathways are usually displaced and compressed, and visual symptoms are common, as well as seizures. The tumor capsule can be thick and very adherent to the anterior cerebral arteries and the small arterial perforators. Radical surgical resection, including the capsule, is the current mainstay of treatment.1-5 The cranio-orbital approach is considered as an excellent surgical access option. Vascular adhesions are associated with a considerable surgical risk to the circle of Willis and its small branches. Residual cyst or perioperative spilling of its content produces severe aseptic meningitis and vasospasm associated with postoperative complications and long-term recurrences.4 This article demonstrates the details of the surgical management of a ruptured suprasellar dermoid cyst in a 22-year-old man. The patient consented to the procedure and publication of images. Image at 2:23 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas, Vol 1, ©LWW, 1998. Illustration at 2:47 reprinted from Surgical Neurology, 50(6), Arnautovic et al, “A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms,” p 17, ©1998, with permission from Elsevier.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.
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Walid Ibn Essayed