Ruptured Intracranial Dermoid: Is surgery indispensible. 11 Year follow up of a rare entity.

BACKGROUND: Dermoid cysts are rare intracranial lesions that can occasionally rupture into intraventricular and subarachnoid spaces and can present with a myriad of symptoms. The surgical intervention in such cases is demanding, because the disseminated contents are spread widely in intraventricular and subarachnoid space. CASE DESCRIPTION: A 22-year-old female patient who presented with history of seizures was diagnosed as having a left parasellar ruptured dermoid. Because there were no features of increased intracranial pressure, conservative management was considered with antiepileptic administration. At 11 years of follow-up, the patient continues to do well on 2 antiepileptics with repeat imaging showing no change in size of lesion. CONCLUSIONS: Surgical intervention may not be essential in all patients with ruptured intracranial dermoids. In a few selected patients who do not manifest increased intracranial pressure and show no change in the size of the lesion on sequential radiologic follow-up, conservative management may be attempted, especially when the ruptured intracranial dermoid is located at eloquent areas and with wide dissemination of contents.