title: A Nonoperative Approach for Neurosurgical Management of a Sylvian Fissure Dermoid Cyst.
abstract: The nonoperative management of sylvian fissure dermoid/epidermoid cysts presents a risk that is difficult to quantify. With rupture, potentially fatal complications such as chemical meningitis, hydrocephalus, fever, seizure, or meningeal irritation may occur. In this paper, we present an asymptomatic case of such a cyst with imaging evidence of prior rupture, and we review the literature for the likelihood of future complications. We use for illustration a case of a 68-year-old woman with imaging features of a sylvian fissure epithelial inclusion cyst who refused surgical intervention and review the literature for further investigation. Conservative management of our patient has not resulted in a complication in over five years, with the continued offer of surgical resection rejected by the patient. This article suggests the possibility of a safe, non-operative management of dermoid/epidermoid cysts of the sylvian fissure; however, the paucity of literature calls for larger studies yielding reliable data regarding the comparative risk of nonoperative management, including the rate of spontaneous rupture, versus the risk and complication incidence of surgical intervention.
authors.affiliation: Texas A&M College of Medicine ; Health Science Center, Scott & White Clinic.
authors.forename: Ali S
authors.initials: AS
authors.lastname: Haider
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Clarence
authors.initials: C
authors.lastname: Kee
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Danielle L
authors.initials: DL
authors.lastname: DeBacker
authors.affiliation: Texas A&M College of Medicine ; Health Science Center, Scott & White Clinic.
authors.forename: Ian T
authors.initials: IT
authors.lastname: Watson
authors.affiliation: UT Houston Medical School, Memorial Hermann.
authors.forename: Eliel N
authors.initials: EN
authors.lastname: Arrey
authors.affiliation: Ross University School of Medicine, Ross University.
authors.forename: Tijani
authors.initials: T
authors.lastname: Osumah
authors.affiliation: Texas A&M College of Medicine.
authors.forename: Dean
authors.initials: D
authors.lastname: Leonard
authors.affiliation: General Surgery, Houston Methodist Hospital.
authors.forename: Chen
authors.initials: C
authors.lastname: Chen
authors.affiliation: Texas A&M College of Medicine ; Health Science Center, Scott & White Clinic.
authors.forename: Maryam
authors.initials: M
authors.lastname: Alam
authors.affiliation: Neuroscience and Experimental Therapeutics, Texas A&M College of Medicine.
authors.forename: L Gerard
authors.initials: LG
authors.lastname: Toussaint Iii
keywords: benign cystic teratoma; dermoid inclusion cyst; epidermoid cyst; intracranial cyst; neurosurgical management; sylvian fissure