Intracranial, supratentorial dermoid cysts in paediatric patients--two cases and a review of the literature.

BACKGROUND: Intracranial dermoid cysts are rare space-occupying lesions in paediatric patients. Supratentorial or lateralized localisations are described even less frequently. Diagnosis may be hard to obtain using standard imaging. Surgical removal provides cure for these benign, but growing lesions.
METHODS: We describe the cases of two paediatric patients in which supratentorially located (one lateralized) dermoid cysts were diagnosed and operated on. Due to unusual presenting symptoms, diagnosis was not straightforward in these cases. Complete resection could be achieved in both patients without any neurological sequelae. We reviewed the current literature available on dermoid cysts in paediatric patients which comprises mainly case reports and only two series. We could identify a total of 61 patients harbouring dermoid cysts. Only ten of these were located supratentorially, and only one was lateralized. DISCUSSION: Most of the midline dermoids were associated with a dermal sinus. Complete surgical removal was discussed as the only treatment option in all cases. Difficulties in diagnosis were reported frequently. Despite good availability of routine MR imaging, the diagnosis of a dermoid cysts, probably due to the low incidence, still remains a challenge. These lesions represent benign intracranial masses. Yet non-neoplastic, they can lead to neurological deficits due to their space-occupying effect.
CONCLUSIONS: Radical surgical resection, if feasible without major risk for the patient, remains the only option of cure. Due to their unusual position and their unique symptomatology, our cases add favourably to the current literature, showing, once more, the multiple facets of this disease.