Perimesencephalic Epidermoid with Obstructive Hydrocephalus: A Case Report on Surgical Management and Postoperative Outcomes

Background Perimesencephalic epidermoid cysts are unusual congenital defects that gradually enlarge into slow-developing obstructive hydrocephalus during their path of pressure on vital cerebrospinal fluid courses. Case Presentation: A 53-year-old male currently suffers from altered sensorium along with forgetfulness that has persisted for eight days. A perimesencephalic epidermoid cyst appeared on MRI as the cause of obstructive hydrocephalus. External ventricular drainage was performed, followed by surgical treatment of the cyst through a left lateral sitting position. The patient experienced temporary pneumocephalus but this problem corrected itself in twelve hours without producing other complications. Glascow Coma Scale scores of the patient rose during the first 24 hours following surgery. Postoperative imaging evaluations showed that the surgical decompression of tumor was sufficient and complete recovery of hydrocephalus occurred. The patient received discharge on postoperative day seven with seizure prophylaxis for the long term along with the requirement for follow-up imaging. Conclusion This case highlights that successful surgical procedures with perioperative management enables the elimination of an obstructive hydrocephalus-causing perimesencephalic epidermoid cyst by achieving positive postoperative outcomes.