Giant Ependymal Cyst of the Temporal Horn – An Unusual Presentation

Abstract

Primary benign cystic lesions in the brain are uncommon. However, extracerebral cysts like arachnoid cyst, epidermoid cyst and craniopharyngiomas are fairly common lesions. Also, colloid cyst in the third ventricle, dermoid cyst and endodermal cyst in the extracerebral location are not uncommon. On the contrary, intraventricular ependymal and choroidal cysts in the intraventricular location are infrequent. Surgical intervention is warranted in cysts, which produce a mass effect and raised intracranial pressure. We present an interesting case of a giant intraventricular ependymal cyst in the temporal horn in a 14-year-old boy, who presented with recent onset of headaches and epilepsy. He also had long-standing progressive proptosis of the left eye and left temporal bossing. Excision of this cystic lesion was curative. Interesting clinical and neuroimaging features are presented.

Contrasting behavior of glio-ependymal cysts: A report of two cases and literature review

“…[13] Surgical intervention may include cysto-peritoneal shunt, [3] cysto-arachnoid shunt, [7] partial excision, [13] marsupilization, [1] fenestration or total excision. [4,8,14] Surgical outcome remains satisfactory without recurrence or repeated surgeries after complete removal.…”

“…Generally, these cysts present in the second or third decade, [4] but have been reported at all ages and even in intrauterine period. [3,5,6] Clinical presentations include seizures, [7,8] symptoms due to mass effect [3,7,8] and some are incidental. [9][10][11] The cyst wall is composed of an inner glial layer with a luminal ependymal lining and an outer fibrous layer with no external lining cells.…”

Case Reports, Arachnoid Cysts with Orbital Bone Remodeling——Two Interesting Cases

“…CT scans are most useful for evaluating bones and the presence of any remodeling, while T2-weighted MRIs are preferred when evaluating the cyst. If asymptomatic, the common symptoms of arachnoid cysts include headaches, seizures, and orbital pain (Pawar et al, 2001).…”

Occipital lobe ependymal cyst with unusual presentation

“…Ependymal cysts represent benign congenital ependymal-lined cysts [1,2] and constitute a very rare cause of neurological symptoms among intracranial cystic lesions [3,4]. As term of terminology, they are designed by several synonyms as "ependymal cyst", "neuroepithelial cyst", "glioependymal cyst" and neuroglial cyst" testifying the dif iculty of naming this disorder.…”