Intracranial dermoid cysts: variations of radiological and clinical features

Background: Intracranial dermoid cysts are uncommon, and their clinical features as well as surgical management differ from patient to patient. Dermoids are generally benign lesions, but may cause spontaneous complications such as meningitis and/or hydrocephalus due to rupture and epileptic seizures depending on their location. Little has been reported about characteristic imaging findings with resulting therapeutic considerations, and only a few reports exist about associated hydrocephalus. Imaging modalities have changed and can facilitate differential diagnosis and follow-up if applied correctly. In this paper, we attempt to contribute our clinical experience with the management of dermoid cysts. Patients and methods: The charts of five men and two women with intracranial dermoid cysts were retrospectively reviewed. The patients were treated between September 1993 and September 2006. Selected patients are presented in detail. Results: Tumour location, size and radiographic characteristics varied in each patient. Clinical presentations comprised focal neurological deficits as well as epileptic seizures, persistent headache, mental changes and psycho-organic syndromes. One patient underwent delayed ventriculo-peritoneal shunting after ruptured fatty particles caused obstructive hydrocephalus. Despite dermoid rupture into the subarachnoid space, three patients never developed hydrocephalus. Diffuse vascular supra-tentorial lesions were seen in one patient as a result of aseptic meningitis. Diffusion-weighted imaging (DWI) hyperintensity in dermoids is related to decrease of water proton diffusion and should be used for both the diagnosis and follow-up of this lesion. Conclusion: Although dermoid cysts are known to be benign entities per se, their rupture can cause a wide range of symptoms including aseptic meningitis and/or hydrocephalus. This may be due to intraventricular obstruction and/or paraventricular compression. While rupture does not necessarily bring about hydrocephalus, radical removal of the tumour and close monitoring of ventricular size is required. Although not widely recognised as such, DWI is considered to be a useful imaging modality in the diagnosis and follow-up of dermoid

An unusual case of a highly progressive supratentorial capillary haemangioblastoma - histopathological considerations.

We describe a case of a rapidly progressive, sporadic, non-von Hippel-Lindau (VHL) disease associated supratentorial capillary haemangioblastoma. Despite the classical histopathological presentation consisting of stromal cells and abundant capillaries, the tumour showed an unfavourable clinical course

Evaluation of a New Brain Tissue Probe for Intracranial Pressure, Temperature and Cerebral Blood Flow Monitoring in Patients with aneurysmal subarachnoid hemorrhage

Objective: To evaluate a brain tissue probe for intracranial pressure (ICP) and temperature (TEMP) monitoring as well as determination of cerebral hemodynamics using a near infrared spectroscopy (NIRS) and indocyanine green (ICG) dye dilution method (NIRS-ICP probe). Methods: The NIRS-ICP probe was applied after aneurysmal subarachnoid hemorrhage if multimodal monitoring was established due to poor neurological condition. ICP and TEMP values were obtained from ventricular catheters and systemic temperature sensors. Repeated NIRS-ICG measurements (2 injections within 30 minutes) were performed daily for determination of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time of ICG (mttICG). Delayed cerebral ischemia was defined as brain tissue oxygen tension 35. Results: A total of 128 NIRS-ICG measurements were performed in 10 patients. The correlation coefficient between ICP and TEMP values obtained with the NIRS-ICP probe and values from routine monitoring was r=0.72 and r=0.96, respectively. The mean value was 30.3 ± 13.6 ml/100g/min for CBF, 3.3 ± 1.2 ml/100g for CBV, and 6.8 ± 1.6 sec for mttICG. The coefficient of variation from repeated NIRS-ICG measurements was 10.9% for CBF, 11.7% for CBV, and 3.8% for mttICG. The sensitivity for delayed cerebral ischemia detection was 85% and the specificity 83% using a CBFthreshold of 25 ml/100g/min. Conclusion: Multimodal monitoring using the NIRS-ICP probe is feasible with high reproducibility of measurement values and the ability to detect delayed cerebral ischemia. No safety concerns exist for the routine clinical use of the NIRS-ICP probe