Management of a rare case of intraventricular ruptured dermoid cyst and chemical meningitis.

INTRODUCTION: Intraventricular dermoid cyst are very rare benign tumour. Due to benign nature, it may go un-noticed for years and might present with sudden rupture. Ruptured cyst can cause chemical meningitis, hydrocephalus, seizures etc. Due to lack of data, there are no defined guidelines about its management. We are reporting an interesting case of ruptured intraventricular dermoid cyst and chemical meningitis, who was managed successfully and will review the literature. CASE REPORT: A 48 years male patient was brought with complaint of sudden mental deterioration, irritability, headache, vomiting for 3 days. He had history of seizures for 1 year. On examination, his higher mental functions were deteriorated, had neck rigidity and left lower limb weakness. CT/MRI brain confirmed diagnosis of right frontal horn ruptured dermoid cyst with scattered fat droplets, hydrocephalus and ventriculitis. Excision of cyst was done via right trans-sulcal (superior frontal sulcus) approach. Patient recovered well. DISCUSSION: Intraventricular dermoid cyst are a rare benign lesion. Due to potential of rupture, it must be surgically treated. Steroids should be used to treat chemical meningitis. Various individual case reports have shown good outcome after surgical management. CONCLUSION: We recommend early surgery, thorough ventricular wash with ringer lactate, post-operative extraventricular drain and steroid cover to manage ruptured cyst and chemical meningitis.

A Rare Case of Intramedullary Lipoma of Brainstem to Thoracic Cord--What to Do?

INTRODUCTION: Intramedullary lipomas are rare, representing 1% of spinal cord tumors. There are less than 25 case reports about cord lipoma extending into brain. Due to paucity of literature, etiology and management are not well established. CASE REPORT: A 14-month-old baby girl was brought with complaints of torticollis toward right side, left upper limb monoplegia, and swallowing difficulty for 6 months. Magnetic resonance imaging brain and spine confirmed the diagnosis of cervicothoracic intramedullary lipoma extending till pontomedullary junction, invading subcutaneous fat. She underwent partial resection of lesion along with decompression. The recovery was good. CONCLUSION: Such lipoma needs extensive pre-, intra-, and postoperative planning. The goal should be decompression, rather than excision. Outcome is good with partial resection.