Delayed ischemic deficit after resection of a large intracranial dermoid: case report and review of the literature.
OBJECTIVE
A unique case of delayed ischemic deficit after resection of a large intracranial dermoid is presented.


METHODS
A 23-year-old woman, 36 hours after the uneventful gross total resection of a large intracranial dermoid cyst, slowly developed a progressive mixed aphasia and right hemiparesis. Magnetic resonance imaging and magnetic resonance angiography revealed small infarcts of the left putamen and temporal-occipital junction and a vasospastic tapering of the left M1 segment.


METHODS
Angiography confirmed severe vasospastic tapering of the left M1 and M2 segments. Endovascular treatment successfully restored flow in the left superior division. However, the initial attempt at low-pressure dilation of the inferior division led to vessel rupture. Seven months after reoperation for emergent trapping of the M1 segment, the patient made an excellent recovery, with only mild right-hand incoordination.


CONCLUSIONS
Ruptured dermoid cysts are a risk for early and delayed cerebral ischemia, and endovascular treatment of dermoid-encased vessels may carry a higher risk for rupture.
Ecker
Robert D
RD
Department of Neurologic Surgery, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA. ecker.robert@mayo.edu
Atkinson
John L
JL
Nichols
Douglas A
DA
D000328:Adult; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000473:pathology; D001932:Brain Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D002533:Cerebral Angiography; D003884:Dermoid Cyst / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D013997:Time Factors