Infratentorial abscess secondary to dermal sinus associated with dermoid cyst in children: Review of the literature and report of a rare case

Abstract

Background: Dermal sinus is usually located at either end of neural tube but most commonly lumbosacral. When occipital, it extends caudally and is mostly localized in the midline position or in the cavity of the fourth ventricle. It could communicate with the skin through a fistula with potential risk of deeper abscesses. Posterior fossa abscess secondary to dermal sinus associated with intracranial dermal cyst is an uncommon pathology. Case Description: A 24-month-old girl was admitted to our institution with a cutaneous fistula in the midline of the occipital region. Brain imaging showed an infratentorial intradiploic cyst with peripheral enhancement to contrast medium. The mass showed hyperintensity on T1-weighted sequences, with the lower signal on T2-weighted images. A suboccipital craniotomy was performed with evacuation of the abscess and excision of the capsule. Contextually a 3 cm whitish and encapsulated cystic mass with hair component was extracted. Histology confirmed the diagnosis of abscess associated with dermal cyst and dermal sinus. The patient condition improved and 15 days after excision, was discharged. The postoperative MRI showed total removal of the lesion. A 36-month follow-up highlighted no evidence of recurrence. Conclusion: Posterior fossa dermoid cyst should be considered in all children with a cutaneous fistula. Early neurosurgical treatment of these benign tumors should be performed to prevent the development of severe intracranial infection. Best results are associated with early diagnosis and complete removal of the abscess. The present work further reviews the few similar cases that have been reported in the literature confirming the need for future research.

A late-diagnosed dermoid cyst complicated with a fistula in the left scapular region: a case report

“…Torsion and wall disruption of the cysts are also common, leading to compression of the circulation and therefore infection and necrosis [ 5 , 8 ].…”

A Rare Presentation of Occipital Dermoid Cyst with Intracranial Extension and Secondary Infection: Case Report and Follow-Up

“…2,3 But an occipital dermoid cyst with intracranial extension is rare and reported in only nine children. [4][5][6][7][8] We report a rare presentation of an occipital dermoid cyst with This article is protected by copyright. All rights reserved.…”

Posterior Fossa Intradural Dermoid Cyst with a Dermal Sinus Complicating with Cerebellar Abscess and Acute Obstructive Hydrocephalus in a Child: Case Report

“…Embryologically, IDCs originate from abnormal inclusion of the ectodermal element into the neural tube between the 3 rd and 5 th week of embryological development [3]. They represent between 0.1% and 0.7% of all intracranial tumours [4]. More rarely, dermoid cysts may communicate with the skin through a narrow tract lined by epithelium (dermal sinus) which, therefore, contains the glandular Case description: Here, we illustrate a PFDC which is exceptionally complicated with Cerebellar abscess and acute obstructive hydrocephalus in an 18-months-old child.…”

“…This rare infectious complication can also occur in PFDC. Colamaria, et al, in their 2021's published literature review, informed that there are only 14 cases of PFDCs associated with cerebellar abscesses that had been reported [4]. The literature, nearly all of the articles about dermoid cysts discuss about their potential infectious complications.…”