preferable. Concern¬ ing the natural history of the disease, I would prefer to base my judgement on its course in patients in whom the diagnosis has been made intraoperatively or at post mortem examina¬ agement
ventriculoperitoneal shunt was done. Improvement of the patient was remark¬ able, with almost complete recovery of normal gait and mentation. At no time did the patient manifest clinical evidence of an inflammatory reaction. A
D. C. Aberfeld, MD 870 UN Plaza New York, NY 10017 1. Brice
Comment—Several authors have re¬ ported the intentional drainage of epidermoid cysts into the ventricle without detectable reaction.35 The granular ependymitis we found cer¬
MD: Spontaneous dissecting aneurysms of the internal carotid artery. Br Med J 2:790-792, 1964. 2. Lloyd J, Bahnson HT: Bilateral dissecting aneurysm of the internal carotid arteries. Am J Surg 122:549-551, 1971. 3. Bostrom K, Liliequist B: Primary dissecting aneurysm of the extracranial part of the internal carotid and vertebral arteries: A report of three cases. Neurology 17:179-186, 1967. 4. Thapedi IM, Ashenhurst EM, Rozdilsky B: Spontaneous dissecting aneurysm of the internal carotid artery in the neck: Report of a case and review of the literature. Arch Neurol 23:549-554, 1970. 5. Anderson RM, Schechter MM: A case of spontaneous dissecting aneurysm of the internal carotid artery. J Neurol Neurosurg Psychiatry 22:195-201, 1959. 6. Burklund CW: Spontaneous dissecting aneurysm of the cervical carotid artery: A report of surgical treatment in two patients. Johns Hopkins Med J 126:154-159, 1970.
Ruptured Intraventricular Dermoid Cyst Without Clinical Inflammation To the Editor.\p=m-\Itis widely thought that a severe inflammatory response ensues if the contents of a dermoid or epidermoid cyst escape into the ventricles or subarachnoid pathways.1 We would like to describe a man who, despite intraventricular-free oil from a dermoid cyst, both preoperatively and postoperatively, failed to manifest any clinical evidence of inflammation.
Report of a Case.\p=m-\This56-year-old man had had a progressive ataxia and mental
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tainly represented response that
Computerized tomogram, demonstrating
free oil in the left lateral ventricle.
deterioration without headache for four years. General health appeared good, but he was grossly demented. There was no papilledema and he had a mild left hemiparesis and an ataxic gait. His neck was supple and he was afebrile. The white blood cell count was 8,100/cu mm and sedimentation rate was 5 mm/hr (Westergren). Roentgenograms showed calcification in the right parasellar area. Computerized tomography disclosed hydrocephalus involving all ventricles. Free oil was seen in the left ventricle, and the disposition of the oil and of the cyst was best demonstrated in the right lateral decubitus position (Fig¬ ure) previously described by Fawcitt and Isherwood.2 e< The lesion was approached through the right lateral ventricle. The cyst wall and ventricular wall were contiguous, and the
cystic content was a bright yellow liquid containing crystals and globules of oil. The septum pellucidum and the attached cyst wall were found to be perforated, allowing
the fluid to enter the left ventricle. A granular ependymitis of the right lateral ventricle was evident, but the surface of the left lateral ventricle appeared normal.
doubt extended into
the subarachnoid pathways to produce the four-ventricle hydrocephalus and perhaps forestall the appearance of meningitis. With the drainage of the ventricles into the peritoneum, our patient's course has been excellent. C. J. Hash, MD Div of Neurosurgery Medical College of Pennsylvania Philadelphia, PA 19129 D. J. Ritchie, MD Dept of Radiology
Pennsylvania Hospital Philadelphia, PA 19107
1. Northfield DWC: Cysts and other spaceoccupying lesions, in Northfield DWC: The Surgery of the Central Nervous System. Oxford, England, Blackwell Scientific Publications, 1973, pp 197-228. 2. Fawcitt RA, Isherwood I: Radiodiagnosis of intracranial pearly tumors with particular reference to the value of computer tomography. Neuroradiology 11:235-242, 1976. 3. Muller PJ, Russell NA, Morley TP: Craniopharyngioma: Results of surgical treatment without radiotherapy, in Morley TP (ed): Current Controversies in Neurosurgery. Philadelphia, WB Saunders Co, 1976, pp 344-350. 4. Patrick BS, Smith RR, Bailey TO: Aseptic meningitis due to spontaneous rupture of craniopharyngioma cyst. J Neurosurg 41:387-390, 1974. 5. Scarff JE: A new method for treatment of cystic craniopharyngioma by intraventricular drainage. Arch Neurol Psychiatr 46:843-867, 1941.