Recurrent cerebellar abscess secondary to cranial dermal sinus associated with dermoid cyst in children
Background: Posterior fossa dermoid cysts are rare, benign lesions whose diagnosis can be quite challenging because of their slow growth and subsequent paucity of symptoms. We present herein an unusual case of recurrent cerebellar abscesses induced by an adjacent extradural dermoid cyst with a complete occipital dermal sinus.
Methods: The authors report the case of a 20-month-old girl who presented with signs of acutely raised intracranial pressure and whose head scans showed a left cerebellar hemisphere abscess associated with obstructive hydrocephalus. The patient was treated initially with an external ventricular drain, followed by burr-hole aspiration of the abscess and long-term
antibiotics. Since the cerebellar abscess recurred, a posterior fossa craniotomy was performed and gross total resection of the lesion along with the dermal sinus tract and abscess contents was achieved. Histopathological analysis confirmed a dermoid tumor.
Conclusions: The occurrence of recurrent cerebellar abscesses must always rise up the suspicion of an associated dermoid cyst. Neuroradiological scans should be carefully evaluated in search for this lesion. Once the diagnosis is established, radical resection of the cyst, sinus tract and infectious components is the treatment of choice.
Akhaddar A, Jiddane M, Chakir N, El Hassani R, Moustarchid B, Bellakhdar F. Cerebellar abscesses secondary to occipital dermoid cyst with dermal sinus. Case report. Surg Neurol. 2002; 58(3-4): 266 –70.
Cai CQ, Zhang QJ, Hu XL, Wang CX. Dermoid cyst of the posterior fossa associated with congenital dermal sinus in a child. World J Pediatr. 2008; 4(1):66-9.
Caldarelli M, Massimi L, Kondageski C, Di Rocco C. Intracranial midline dermoid and epidermoid cysts in children. J Neurosurg. 2004; 100(5): 473–480.
Costa JM, de Reina L, Guillén A, Claramunt E. Occipital dermal sinus associated to a cerebellar abscess. Case. Neurocirugia (Astur). 2005; 15(5):480-3.
Douvoyiannis M, Goldman DL, Abbott IR 3rd, Litman N. Posterior fossa dermoid cyst with sinus tract and meningitis in a toddler. Pediatr Neurol. 2008; 39(1):63-6.
García Galera A, Martínez León MI, Pérez da Rosa S, Ros López B. Cerebellar abscesses secondary to infection of an occipital dermal sinus. Radiologia. 2013; 55(5):443-6.
Goffin J, Plets C, Calenbergh F. Posterior fossa dermoid cyst associated with dermal fistula: report of 2 cases and review of the literature. Child’s Nerv Syst. 1993; 9(3):179 – 81.
Groen RJ, Van Ouwerkerk WJ. Cerebellar dermoid tumor and occipital meningocele in a monozygotic twin: clues to the embryogenesis of craniospinal dysraphism. Child’s Nerv Syst. 1995; 11:414 –7.
Guidetti B, Gagliardi FM. Epidermoid and dermoid cysts: clinical evaluation and late surgical results. J Neurosurg. 1977; 47(1):12– 8.
Hayek G, Mercier P, Fournier HD, Menei P, Pouplard F, Guy G. Dermal sinus and dermoid cyst revealed by abscess formation in posterior fossa. Report of 2 pediatric cases and review of the literature. Neurochirurgie. 2001; 47(2-3): 123–127.
Higashi S, Takinami K, Yamashita J. Occipital dermal sinus associated with dermoid cyst in the fourth ventricle. Am J Neuroradiol. 1995; 16(4):945– 8.
Kamide T, Yokoyama T, Iwasa T, Shimizu M, Araki R, Niida Y, Nakada M, Yachie A. Mollaret Meningitis Associated with Occipital Dermal Sinus. J Pediatr. 2009; 155(5):757.
Karagöz Güzey F, Bas NS, Sencer A, Emel E, Hamamcioglu MK, Ozkan N, Hepgul K, Aycan A. Posterior fossa dermoid cysts causing cerebellar abscesses. Pediatr Neurosurg. 2007; 43(4):323-6.
Layadi F, Louhab N, Lmejjati M, Aniba K, Aït Elqadi A, Aït Benali S. Cerebellar dermoid cyst with occipital dermal sinus. Report of two pediatric cases. Pediatr Neurosurg. 2006; 42(6):387– 390.
Lee JK, Kim JH, Kim JS, Kim TS, Jung S, Kim SH, Kang SS, Kim JH. Cervical dermal sinus associated with dermoid cyst. Childs Nerv Syst. 2001; 17(8):491–493.
Logue V, Till K. Posterior fossa dermoid cysts with special reference to intracranial infection. J Neurol Neurosurg Psychiatry. 1952; 15(1):1–12.
Lunardi P, Missori P, Galiardi FM, Fortuna A. Dermoid cysts of the posterior fossa in children. Report of nine cases and review of the literature. Surg Neurol. 1990; 34(1):39 – 42.
Mann GS, Gupta A, Cochrane DD, Heran MK. Occipital dermoid cyst associated with dermal sinus and cerebellar abscesses. Can J Neurol Sci. 2009; 36(4):487-90.
Martens F, Ectors P, Noel P, Hanquinet S, Faverly D. Unusual cause of cerebellar abscess: occipital dermal sinus and dermoid cyst. Neuropediatrics. 1987; 18(2): 107–109.
Martínez-Lage JF, Ramos J, Puche A, Poza M. Extradural dermoid tumours of the posterior fossa. Arch Dis Child. 1977 77(5):427-30.
Matson D, Ingraham F. Intracranial complications of congenital dermal sinuses. Pediatrics. 1951; 8(4): 463–474.
Ramzan A, Khursheed N, Rumana N, Abrar W, Ashish J. Posterior Fossa Dermoid With Klippel-Feil Syndrome in a Child. Pediatric Neurology. 2011; 45(3):197-199.
Rubin G, Scienza R, Pascualin A, Rosa L, DaPian R. Craniocerebral epidermoids and dermoids. Acta Neurochir (Wien). 1989; 97(1-2):1–16.
Schijman E, Monges J, Cragnaz R. Congenital dermal sinuses, dermoid and epidermoid cysts of the posterior fossa. Child’s Nerv Syst. 1986; 2(2):83– 6.
Tekkok IH, Baeesa SS, Higgins MJ, Ventureyra EC. Abscedation of posterior fossa dermoid cysts. Childs Nerv Syst. 1996; 12(6): 318–322.
Turgut M. Klippel–Feil syndrome in association with posterior fossa dermoid tumour. Acta Neurochir. 2009; 151(3):269–276.
Wiemer DR. An occipital dermoid tumor and sinus. Ann Plast Surg. 1988; 21(5):465–7.
Yang B, Jin HM, Sun LP, Cai W, Shi CR. Posterior Fossa Abscesses Secondary to Dermal Sinus Associated with Dermoid Cyst in Children. Neuropediatrics. 2008; 39(1): 39–42.
Youklif I, Hilmani S, Naja A, Ibahiouin K, Sami A, Achouri M, Ouboukhlik A, El Kamar A, El Azhari A. Dermal sinus and dermoid cyst complicated by abscess formation. J Neuroradiol. 2006; 33(2):139-40.