Delayed ischemic deficit after resection of a large intracranial dermoid: Case report and review of the literature

Robert D. Ecker, John L. Atkinson, Douglas A. Nicholsv, M. Gazi Yaşargil, Saleem I. Abdulrauf, Ossama Al-Mefty, William F. Chandler

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE AND IMPORTANCE: A unique case of delayed ischemic deficit after resection of a large intracranial dermoid is presented. CLINICAL PRESENTATION: A 23-year-old woman, 36 hours after the uneventful gross total resection of a large intracranial dermoid cyst, slowly developed a progressive mixed aphasia and right hemiparesis. Magnetic resonance imaging and magnetic resonance angiography revealed small infarcts of the left putamen and temporal-occipital junction and a vasospastic tapering of the left M1 segment. INTERVENTION: Angiography confirmed severe vasospastic tapering of the left M1 and M2 segments. Endovascular treatment successfully restored flow in the left superior division. However, the initial attempt at low-pressure dilation of the inferior division led to vessel rupture. Seven months after reoperation for emergent trapping of the M1 segment, the patient made an excellent recovery, with only mild right-hand incoordination. CONCLUSION: Ruptured dermoid cysts are a risk for early and delayed cerebral ischemia, and endovascular treatment of dermoid-encased vessels may carry a higher risk for rupture.

Original languageEnglish (US)
Pages (from-to)706-710
Number of pages5
JournalNeurosurgery
Volume52
Issue number3
StatePublished - Mar 1 2003

Fingerprint

Dermoid Cyst
Aphasia
Rupture
Magnetic Resonance Angiography
Putamen
Paresis
Ataxia
Brain Ischemia
Reoperation
Dilatation
Angiography
Hand
Magnetic Resonance Imaging
Pressure
Therapeutics

Keywords

  • Delayed ischemic deficit
  • Dermoid
  • Stroke
  • Vasospasm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Ecker, R. D., Atkinson, J. L., Nicholsv, D. A., Yaşargil, M. G., Abdulrauf, S. I., Al-Mefty, O., & Chandler, W. F. (2003). Delayed ischemic deficit after resection of a large intracranial dermoid: Case report and review of the literature. Neurosurgery, 52(3), 706-710.

Delayed ischemic deficit after resection of a large intracranial dermoid : Case report and review of the literature. / Ecker, Robert D.; Atkinson, John L.; Nicholsv, Douglas A.; Yaşargil, M. Gazi; Abdulrauf, Saleem I.; Al-Mefty, Ossama; Chandler, William F.

In: Neurosurgery, Vol. 52, No. 3, 01.03.2003, p. 706-710.

Research output: Contribution to journalArticle

Ecker, RD, Atkinson, JL, Nicholsv, DA, Yaşargil, MG, Abdulrauf, SI, Al-Mefty, O & Chandler, WF 2003, 'Delayed ischemic deficit after resection of a large intracranial dermoid: Case report and review of the literature', Neurosurgery, vol. 52, no. 3, pp. 706-710.
Ecker RD, Atkinson JL, Nicholsv DA, Yaşargil MG, Abdulrauf SI, Al-Mefty O et al. Delayed ischemic deficit after resection of a large intracranial dermoid: Case report and review of the literature. Neurosurgery. 2003 Mar 1;52(3):706-710.
Ecker, Robert D. ; Atkinson, John L. ; Nicholsv, Douglas A. ; Yaşargil, M. Gazi ; Abdulrauf, Saleem I. ; Al-Mefty, Ossama ; Chandler, William F. / Delayed ischemic deficit after resection of a large intracranial dermoid : Case report and review of the literature. In: Neurosurgery. 2003 ; Vol. 52, No. 3. pp. 706-710.
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