Journal of Molecular Virology and Immunology

 

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Case Report

doi: 10.46683/jmvi.2021.31

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Ahmed ADAM OSMAN1 [ID], Nur ABDULLAHİ KARSHE2 [ID], İsmail GEDİ İBRAHİM1 [ID], Mehmet TAHTABAŞI3 [ID]

1Department of Radiology, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, University of Health Sciences, Mogadishu, Somalia.

2Department of Neurosurgery, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, University of Health Sciences, Mogadishu, Somalia.

3Department of Radiology, Mehmet Akif Inan Education and Research Hospital, University of Health Sciences, Şanlıurfa, Turkey.

Article Info: Received: 18.04.2021. Accepted: 20.05.2021.

Publication date: 22.05.2021.

Correspondence: Ahmed Adam Osman; MD., Department of Radiology, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, University of Health Sciences, Mogadishu, Somalia. E-mail: fahadyare41@gmail.com

A Leptomeningeal Cyst in the Frontal Bone as a Complication of Childhood Head Trauma: A Case Report

 

Çocukluk Çağı Kafa Travmasının Bir Komplikasyonu Olarak Frontal Kemikte Leptomeningeal Kist: Olgu Sunumu

Abstract

Leptomeningeal cysts secondary to trauma represent an extremely rare complication of calvarial fractures experienced during childhood. The early diagnosis and surgical treatment of such cysts can serve to prevent neurological sequelae. A 23-year-old male from a remote region attended the neurosurgery department complaining of headache, insomnia, and slowly progressing swelling over the right frontal region. The patient reported experiencing trauma (cow horn) in the same region of the head some 15 years previously. Non-contrast cranial computed tomography showed a lytic calvarial lesion with a large cystic area in the right frontal bone. Further, brain magnetic resonance imaging (MRI) revealed hyperintensity on the T2-weighted MRI and no enhancement on the T1-weighted post-contrast images. Moreover, there was no restricted diffusion corresponding to the cystic lesion in the frontal region. The dura mater and the bone gap were repaired using titanium mesh. The patient, whose headache and insomnia symptoms had completely disappeared, was discharged five days after the operation.

Özet

Travmaya sekonder leptomeningeal kistler, çocukluk çağında yaşanan kalvarial kırıkların son derece nadir bir komplikasyonunu temsil eder. Bu tür kistlerin erken teşhisi ve cerrahi tedavisi nörolojik sekelleri önlemeyi sağlayabilir. Kent merkezine uzak bir bölgeden gelen 23 yaşındaki genç bir erkek baş ağrısı, uykusuzluk ve sağ frontal bölgede yavaş ilerleyen şişlik şikayetleri ile beyin cerrahisi bölümüne başvurdu. Hasta yaklaşık 15 yıl önce başın aynı bölgesinde bir travma (inek boynuzu) yaşadığını bildirdi. Kontrastsız bilgisayarlı tomografide sağ frontal kemikte geniş bir kistik alana sahip litik bir kalvariyal lezyon görüldü. Ayrıca, beyin manyetik rezonans görüntüleme (MRI), T2 ağırlıklı MRI'da hiperintensite ve T1 ağırlıklı kontrast sonrası görüntülerde herhangi bir artış olmadığını ortaya koydu. Ayrıca frontal bölgedeki kistik lezyona karşılık gelen sınırlı difüzyon yoktu. Dura mater ve kemik boşluğu titanyum ağ kullanılarak onarıldı. Baş ağrısı ve uykusuzluk semptomları tamamen kaybolan hasta operasyondan beş gün sonra taburcu edildi.

 

Keywords: Leptomeningeal cyst, Intradiploic leptomeningeal cyst, Headache, Calvarial defect.

Anahtar kelimeler: Leptomeningeal kist, Intradiploik leptomeningeal kist, Baş ağrısı, Kalvariyal defekt.

Figure 1. Lateral skull image (A) demonstrates the 4 cm diameter of a well-defined lytic lesion in the right frontal bone. The non-contrast axial and sagittal computed tomography scans of the brain (B, C) demonstrate a large calvarial defect in the right frontal lobe with a cystic lesion of the same density as the cerebrospinal fluid.

Figure 1 png

Figure 2. Axial post-contrast T1-weighted image (A) shows that the cyst is hypointense and has no contrast enhancement. Sagittal T2-weighted image (B) reveals a large calvarial defect and a cystic lesion. Diffusion-weighted image (C) shows that the cyst has no restricted diffusion.

Figure 2 png

Figure 3. (A) A U-shaped scalp flap incision with a circular craniotomy. (B) The bone defect was repaired using titanium mesh. (C) The inner side of the cyst was covered by a thin endosteal layer of the dura. (D) The outer part was covered by a glial layer.

Figure 3 png

©Copyright JMVI. Licenced by Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).

Cite this article: Adam Osman A, Abdullahi Karshe N, Gedi İbrahim İ, Tahtabaşı M. A Leptomeningeal Cyst in the Frontal Bone as a Complication of Childhood Head Trauma: A Case Report. J Mol Virol Immunol 2021; 2(2): 52-55. doi: 10.46683/jmvi.2021.31

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