Spontaneous rupture of a clinically recurrent intracranial dermoid cyst: a case report and narrative review

Hongyuan Liu, Hui Zeng, Bufan Yang, Yuzhu Ji, Zongping Li, Liangxue Zhou

Objective To describe the clinical, pathological, and therapeutic features of spontaneous rupture of a recurrent intracranial dermoid cyst (IDC), and to summarize relevant dermoid-specific literature. Methods We report a 38-year-old woman with a clinical history of resection of a left middle and posterior cranial fossa dermoid cyst more than 10 years earlier. She presented with headache and vomiting, and imaging suggested rupture of a recurrent lesion with cerebrospinal fluid (CSF) dissemination. Emergency microsurgical resection assisted by neuroendoscopy was performed. Six months postoperatively, she developed delayed obstructive hydrocephalus, requiring neuroendoscopic fenestration and lesion debridement. A narrative literature review of ruptured intracranial dermoid cysts (IDCs) was performed, with emphasis on lesions, dissemination patterns, hydrocephalus, treatment, and reported outcomes. Results During the initial emergency surgery, the cyst exhibited paste-like consistency with a thickened capsule. Postoperative pathology confirmed a dermoid cyst. However, disseminated foci remained within the cerebral sulci and ventricles. The second surgery revealed multiple pearl-like lesions within the ventricular system with associated lipid leakage. Following clearance of these lesions, the hydrocephalus resolved. Conclusion Spontaneous rupture of a recurrent IDC is exceptional and may be followed by extensive ventricular dissemination and delayed hydrocephalus. This necessitates a profound understanding of the associated risks, enhanced follow-up protocols, and timely intervention.