Sylvian fissure epidermoid cyst
Epidermoid cysts within the Sylvian fissure are extremely rare. Expressive aphasia, and cognitive disorder because of mass effect have never been reported previously.
Zenonos et al. from the Department of Neurosurgery, University of Pittsburgh Medical Center, USA, discuss the case of a 53 year old male who presented with an acute episode of expressive aphasia and vision changes along with progressive headaches and cognitive decline over the past 2.5 years. A detailed neurological examination revealed subtle conduction aphasia, as well as mild short-term memory impairment. Magnetic resonance imaging revealed a cystic mass consistent with epidermoid cyst within the left Sylvian fissure. High Definition Fiber-Tractography showed that the arcuate fasciculus was stretched by the tumor. A left frontotemporal craniotomy allowed for near-total excision of the cyst and led to rapid and complete resolution of symptoms.
Although rare, epidermoid cysts of the dominant sylvian fissure can present with progressive aphasia due to mass effect on the arcuate fasciculus. Despite the long-standing symptoms, surgical resection can lead to their complete resolution 1).
A 27-year-old female with a large epidermoid cyst located in the right Sylvian fissure who presented with a headache, hearing impairment and tinnitus. She underwent craniotomy and complete resection of the tumor with the resolution of the tinnitus. Such location and presentation are rarely encountered for epidermoid tumors 2).
Shah et al. report the case of a 24-year-old male with a large sylvian fissure epidermoid tumor who presented with intention tremor. The patient was operated, and a near-total excision of the tumor was performed with a resolution of the tremor 3).
A patient with unruptured dermoid cyst in the left sylvian fissure who was operated successfully without any residual deficit 4).