Unusual Radiographic Presentation of Intracranial Mature Teratoma and Resection via Supraorbital Approach

Abstract

Background: Primary intracranial teratomas account for <1% of intracranial masses during childhood after infancy. When supratentorial, they commonly occur in the pineal and suprasellar regions, demonstrating multilocularity, areas of fat, and calcifications and increasing enhancement correlating with decreased maturity. However, the presence of a teratoma as a mobile fat lesion within a large unilocular suprasellar cyst is rarely documented in this patient population.

Case description: We present the first pediatric case of a suprasellar mature teratoma presenting as a mobile fat suppressing lesion within a large unilocular suprasellar cyst and describe a supraorbital approach with adjunctive use of the endoscope for resection. We also provide a literature review of other cases presenting with similar radiographic findings.

Conclusions: Mature teratomas may manifest atypically as unilocular cystic lesions with a central mobile fatty component and are treated by gross total surgical resection. The supraorbital approach with adjunctive use of an endoscope can provide adequate exposure for resection with optimal cosmetic outcome.

Keywords: Endoscope; Fat globules; Supraorbital; Teratoma.