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Histopathological findings -(a) cyst lined by squamous epithelium with granular layer containing laminated keratin, consistent with epidermoid cyst. (b) Adjacent relatively uninvolved cerebellar parenchyma. (c) Necrosis with inflammation, granulation tissue, and giant cells. (d) Degenerating keratinocytes with inflammation and histiocytic reaction.
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Background
Chemical meningitis, a subtype of aseptic meningitis, as a complication of posterior fossa surgery is not a rare complication. However, the description of a severe protracted course following the surgical resection of an epidermoid cyst has not been described in the current literature. Chemical meningitis is thought to be associated with...
Citations
... Aseptic meningitis secondary to rupture of an epidermoid cyst into the cerebrospinal fluid (CSF) spaces is a rare, but previously documented event [1]. Aseptic meningitis following posterior fossa surgery is not an uncommon complication, however it appears to occur more frequently in patients having epidermoid cysts resected [2]. no surgical benefit from removing a portion of the petrous bone, unlike a meningioma where devascularisation can greatly improve the safety of surgery. ...
... [2] Aseptic meningitis can be complicated by seizures. [1] Acute onset right facial palsy and double vision suggest ischemic stroke. We should be informed whether diffusion weighted images, apparent diffusion coefficient maps, and perfusion-weighted images were also performed to rule out a cytotoxic lesion in the context of an ischemic stroke. ...
... We thank the authors for their thoughtful commentary accompanying our paper, "Protracted Course of Chemical Meningitis Following Posterior Fossa Epidermoid Cyst Excision -Case Report. " [1] e points raised are well received, and we aim to provide clarity. ...
... [2] Aseptic meningitis can be complicated by seizures. [1] Acute onset right facial palsy and double vision suggest ischemic stroke. We should be informed whether diffusion weighted images, apparent diffusion coefficient maps, and perfusion-weighted images were also performed to rule out a cytotoxic lesion in the context of an ischemic stroke. ...
... We thank the authors for their thoughtful commentary accompanying our paper, "Protracted Course of Chemical Meningitis Following Posterior Fossa Epidermoid Cyst Excision -Case Report. " [1] e points raised are well received, and we aim to provide clarity. ...
We read with interest the article by Ehrlich et al. about a 33-year-old female who developed aseptic meningitis following the redoresection for a fourth ventricular epidermoid cyst. [2] e postsurgical course was complicated by recurrent fever, sub-occipital pseudomeningocele, hydrocephalus, leptomeningeal enhancement, neutrophil pleocytosis, and hypoglycorrhachia, why she was repeatedly treated with steroids and antibiotics, despite repeatedly negative cerebrospinal fluid (CSF) cultures, and placement of a ventriculoperitoneal shunt (VPS). [2] Because of recurrent shunt dysfunction, several revisions of the VPS had to be carried out. [2] A second sub-occipital craniotomy and posterior fossa exploration was non-informative. [2] Finally, the patient made an incomplete recovery under long-term treatment with prednisone. [2] e study is appealing but raises concerns that warrant further discussion. A limitation of the study is that the results of reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were not reported. [2] As the case coincided with the SARS-CoV-2 pandemic, it is crucial that acute infection with SARS-CoV-2, long-COVID, or post SARS-CoV-2 vaccination syndrome are appropriately ruled out. ere is also no mention of whether or not a virus panel, including human immunodeficiency virus, was conducted and, if conducted, whether it was informative or noninformative. A further limitation of the study is that the CSF was tested neither for fungi nor for mycobacterium tuberculosis. ere is also no mention whether the CSF was tested for antibodies associated with immune encephalitis. Involvement of the cerebral parenchyma as shown in Figure 4 should prompt the exclusion of encephalitis. Another limitation of the study is that the patient did not undergo electroencephalography recordings when she developed episodes of confusion 6 weeks after removal of the epidermoid cyst. [2] Aseptic meningitis can be complicated by seizures. [1] Acute onset right facial palsy and double vision suggest ischemic stroke. We should be informed whether diffusion weighted images, apparent diffusion coefficient maps, and perfusion-weighted images were also performed to rule out a cytotoxic lesion in the context of an ischemic stroke. Missing are the results of the CSF cytology investigation. Missing is the profile of CSF cytokines, chemokines, and glial factors.
