Fourth Ventricular Dermoid Cyst
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Dermoid cysts are quite rare. Let's review the case of one of these tumors within the fourth ventricle. This is a 52-year-old male who presented with headaches and gait ataxia, was noted to have mild hydrocephalus on MRI examination, and also a fat-containing tumor within the fourth ventricle. You can see the relatively heterogeneous enhancement pattern with marginal enhancement of the mass within the fourth ventricle. A midline suboccipital craniotomy and the telovelar approach were used for resection of this tumor. You can see the midline incision. I like the lateral position so I can sit during the microsurgical part of the operation. In addition, the gravity can clear the operative field. The dura was opened, arachnoid bands were also incised. You can see the tumor protruding through the foramen Magendie. Retractors gently mobilized the tonsils. You can see evidence of fat and hair within the tumor. The tumor can be easily debulked and removed. The capsule of the tumor that was plastered to the floor of the fourth ventricle was obviously left intact. The tumor was removed until the aqueduct was apparent. Again, additional tumor was removed within the blind spot of the surgeon, which is often superior and posterior. Endoscopy can assist with inspection of these blind spots. Here's another view of the final operative corridor, the aqueduct, the residual capsule. Postoperative MRI demonstrates complete resection of the tumor and resolution of the hydrocephalus, and this patient's preoperative symptoms resolved. Thank you.
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