Disclosures: Jennifer M. Cushman, MD: Nothing to disclose

Case Description: Patient admitted for acute inpatient rehabilitation post craniotomy with resection of suprasellar epidermoid cyst. Surgery was complicated by post-operative right-thalamic, left-caudate stroke, left-frontal hemorrhage, seizures, and hyponatremia due to SIADH. Patient was found to have mixed language and bilateral visual field deficits, mixed oral-pharyngeal dysphagia, and hemiparesis. Multidisciplinary rehabilitation was started, he failed to improve, CT scan revealed hydrocephalus with midline shift leading to neurosurgery consult. Patient was started on dexamethasone 4 mg 3× day, and continued to decline. A repeat head CT did not show improvement so he had VP shunt placed emergently.

Setting: Stand-Alone inpatient Rehabilitation Facility

Patient: A 69-year-old M presented with complications following elective surgical resection of epidermoid cyst.

Assessment/Results: This is a rare case of epidermoid brain tumor complicated by hydrocephalus and midline shift following tumor resection. Patient was discharged from inpatient rehabilitation due to decline and VP shunt was placed emergently.

Discussion: Epidermoid cysts, congenital in origin, account for roughly 1% of intracranial tumors. They arise from epithelial cells retained during neural tube closure. Because of the growth along cranial nerves and tissue planes, symptoms are usually present and gross total resection is near impossible. These tumors arise from inclusion of ectodermal epithelial elements with a benign course and slow progression. It may present as an extra-cerebral intradural lesion in about 40% of cases, with most tumors located in the cerebellopontine angle. Tumor is avascular in nature, comprised of cholesterol and keratin in a solid crystalline state.

Conclusion: This case highlights a patient’s post-operative resection complications, including hydrocephalus with midline shift, discovered by the rehabilitation team and managed in a timely manner. This rare presentation stresses the importance of multidisciplinary management in a rehabilitation setting and the need of close monitoring of post-operative neurosurgical patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/extremely-rare-presentation-and-the-complicated-rehabilitation-course-of-external-hydrocephalus-following-epidermoid-tumor-resection-a-case-report/