PMC8641637_01
(A,B,C,D) axial non contrast CT scan showing CPA arachnoid cyst of the cerebellopontine angle (1), a vermian dermoid cyst (2) and significant dilatation of the third ventricle and lateral ventricles
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F1
Computed tomography (CT) scan visualized two cystic formations of the posterior cerebral fossa with active tri-ventricular hydrocephalus (Figure 1).
A) cerebral MRI in axial section performed in T1; B) cerebral MRI in axial section performed in T2 mode showing the arachnoid cyst of the left cerebellopontine angle (1) in hypo-signal T1 (A) and in hyper-signal T2 (B) and the vermian dermoid cyst (2) in hypo-signal T1 (A) and slightly in hyper-signal T2 (B)
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F2
Therapeutic interventions and follow-up: a ventriculoperitoneal shunt has been placed in an emergency which allowed normalization of consciousness and cerebral magnetic resonance imaging (MRI) was performed later on and has confirmed the arachnoid cyst of the cerebellopontine angle (CPA) and vermian dermoid cyst which compress the brainstem anteriorly (Figure 2).
(A,B,C,D) per-operative view of the dermoid cyst being completely removed using a median sub-occipital approach
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F3
A second surgical procedure was performed to remove the vermian dermoid cyst, through a medial sub-occipital craniectomy (Figure 3) and performing a post-operative CT scan showing a total removal of the dermoid cyst and the perfect placement of the ventriculoperitoneal valve (Figure 4, Figure 5).
postoperative cerebral CT scan which allows to visualizing the total excision of the dermoid cyst via the median sub-occipital approach, as well as the arachnoid cyst of the cerebellopontine angle not yet operated
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F4
A second surgical procedure was performed to remove the vermian dermoid cyst, through a medial sub-occipital craniectomy (Figure 3) and performing a post-operative CT scan showing a total removal of the dermoid cyst and the perfect placement of the ventriculoperitoneal valve (Figure 4, Figure 5).
the cerebral CT scan also shows the right frontal ventriculoperitoneal shunt valve in place, with normal-sized ventricles
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F5
A second surgical procedure was performed to remove the vermian dermoid cyst, through a medial sub-occipital craniectomy (Figure 3) and performing a post-operative CT scan showing a total removal of the dermoid cyst and the perfect placement of the ventriculoperitoneal valve (Figure 4, Figure 5).
A) cerebral CT scan; B) cerebral MRI show a collapse of the arachnoid cyst from the cerebellopontine angle and total excision of the vermian dermoid cyst
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F6
The postoperative observation showed the disappearance of the lateral deviation of the eyes and six months CT scan showed the decrease in the size of the CPA arachnoid cyst (Figure 6).