Good afternoon,My 10 year old son fell from a slide and facial xrays were taken. no fx, but a cyst with sclerotic margins was noted on left temporal bone. An MRI was done (hoping to gather information w/o radiation exposure). A dermoid cyst of the brain was noted adjacent to bone area in question. Dermoid cyst are usually not cancer, correct? A neurosurgeon here wants to obtain a CT w/o contrast. Through the referral system and authorization, a waiting game has begun. My son has no neurologic sxs, but my husband and I are very concerned if this may be a cancer lesion? If not, is yearly MRIs to monitor adequate? thank you for your time. LaRue Hauenstein
Person's Gender: Male
Person's Age: 10
are you there?
so you have a question about dermoids?
is it near his eye?
it sounds like he has what is known as a periorbital dermoid cyst
no. the MRI shows it on his brain adjacent to left temporal bone and that area of the bone looks sclerotic
ok. so the dermoid is in the arachnoid space adjacent to the brain and inside the skull and the inner table of the skull, which is thin is showing an inflammatory reaction and becoming sclerotic
I believe these types of dermoids are always benign, but if you can hang on, i would like to check my neurosurgical source information, ok?
ok, so this is the situation. If this is a dermoid cyst, this is a congenital type dermoid, (he never had any type of needle injection into that area while a newborn for any reason, correct?)
so this is a defect of embyrogenesis. It the very early stages, the first month of life while in utero, there is closure of the neural tube and formation of that structure into the brain, then there are mesenchymal cells that make muscle connective tissue and bone that are laying right against the neural tube, one or more cells of mesenchymal origin got stuck in a place next to the neural tube and developed into this dermal cyst. It was kind of a cell not being in the right place.
now as he developed, that one cell developed, it was a pluripotential cell, so it could have turned into one or many differnent things all in one, kind of like a little part of his body all of its own part bony, part connective tissue, etc, but is doesn't communicate with his body, do you understand, it is enclosed as a cyst
and it is in the space between his brain and his skull, now his skull reacted because of the pressure condition it posed.
and it should come out. but the key to taking it out is to get it all out, and to make sure that you do not rupture the contents of the cyst when taking it out, because the cells have the capacity to start growing again (maybe) in new places if it leaks.
It is not cancer. it is a miscommunication of embryology, a defect in development, and it should pose no problems unless he gets a seizure from it, which he hasn't correct?
I guess they want to watch it now?
I guess they feel it is entirely dormant at this point
correct, no seizures. So he should have it removed? Will it continue to grow if he doesn't. is the surgery easier as a child or as an adult?
the differential would include an arachnoid cyst, which is entirely normal and should be left alone, but you would not expect sclerosis of the skull with an arachnoid cyst and that may be why they think it is a dermoid
there are also dermoids that grow right inside the skull that are entirely benign, but that is not the case here
We have not seen the Neurosurgeon yet, but he is concerned because of the results he sees on Xray and MRI. We are waiting for the CT.
well these guys are the masters of this issue, I would just sit in their grand rounds to learn the story, is he seeing a peds neurosurgeon?
yes at Loma Linda.
I used to work for neurosurgeons from loma linda many years ago as I did epilepsy surgery -experimental on animals, (you couldn't do that today) for them
they are very radical, let me tell you, are you 7th day adventists?
Is there a certain size of the cyst that seems to start showing sxs?
No we are not 7th day adventist
well the sclerosis is concerning because you do not want this pushing on the cerebral cortex on the other side
and taking it out as a child would be easier than as an adult, but you have to decide if the growth of the cyst warrants its removal
so you need some markers of growth
What doctor/hospital would you recommend?
well, we all have our inborn biases. I am on the east coast, but I did my peds neuro training at Stanford. My sister is there and it is a great peds neuro and neurosurgery program
have you heard good things about Childrens Hospital Orange County or Los Angeles?
the key here is that this is not expanding as we speak, you can wait probably, depending on the bone changes that will be visible on MRI. they may also do a special MRI scan, a perfusion scan and MRA to look at blood flow in the brain around the dermoid
Ok. any other tests we should be aware of? what is a good retesting time to check on growth?
honestly I don't know, I am sure they are good, these are well respected institutions, academic centers, and their peds neurosurgery really follows national guidelines for care. I don't want to put crazy ideas in your head, but loma linda is known for its more aggressive management
I would check again in like 3 months if he is totally asymptomatic as that should provide two time points to measure
ok. thank you so much! you have given us a hugh relief as we are waiting.....thank you for your very detailed explaination.
sure no problem, please get back to me if I can help, and if you think I answered your questions and are satisfied, please hit the accept as that is how I am compensated for my work and thank you. XX. XXXXX T.
your welcome and thank you again
General Adult Neurologist. Board Certified. Experimental Neuroimaging and Neurodiagnostics
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