Spontaneous rupture of a clinically recurrent intracranial dermoid cyst: a case report and narrative review.

OBJECTIVE: To describe the clinical, pathological, and therapeutic features of spontaneous rupture of a recurrent intracranial dermoid cyst (IDC), and to summarize relevant dermoid-specific literature. METHODS: We report a 38-year-old woman with a clinical history of resection of a left middle and posterior cranial fossa dermoid cyst more than 10 years earlier. She presented with headache and vomiting, and imaging suggested rupture of a recurrent lesion with cerebrospinal fluid (CSF) dissemination. Emergency microsurgical resection assisted by neuroendoscopy was performed. Six months postoperatively, she developed delayed obstructive hydrocephalus, requiring neuroendoscopic fenestration and lesion debridement. A narrative literature review of ruptured intracranial dermoid cysts (IDCs) was performed, with emphasis on lesions, dissemination patterns, hydrocephalus, treatment, and reported outcomes. RESULTS: During the initial emergency surgery, the cyst exhibited paste-like consistency with a thickened capsule. Postoperative pathology confirmed a dermoid cyst. However, disseminated foci remained within the cerebral sulci and ventricles. The second surgery revealed multiple pearl-like lesions within the ventricular system with associated lipid leakage. Following clearance of these lesions, the hydrocephalus resolved. CONCLUSION: Spontaneous rupture of a recurrent IDC is exceptional and may be followed by extensive ventricular dissemination and delayed hydrocephalus. This necessitates a profound understanding of the associated risks, enhanced follow-up protocols, and timely intervention.