REVIEW
Os cistos dermoides de inclusão congênita (CDICs) são lesões raras e benignas, comumente encontradas sobre a fontanela anterior. Esses cistos são tipicamente suaves, móveis, indolores e podem crescer progressivamente, sendo a maioria dos casos diagnosticada na primeira infância. Uma revisão de 24 estudos destacou os principais achados clínicos, laboratoriais, histopatológicos e neurorradiológicos dos CDICs. A idade média no diagnóstico é de 5,3 anos. A análise laboratorial frequentemente revela fluido claro ou turvo contendo queratina e material sebáceo, às vezes assemelhando-se ao líquido cefalorraquidiano (LCR), o que ajuda a diferenciar os CIDCs de outros cistos. Histopatologicamente, os CDICs apresentam epitélio estratificado pavimentoso com apêndices como folículos pilosos e glândulas sebáceas, confirmando o diagnóstico. A neuroimagem revela lesões císticas sem evidências de envolvimento intracraniano. A excisão cirúrgica é o tratamento de escolha e geralmente resulta em desfechos favoráveis com complicações mínimas. É apresentado o caso de uma paciente de 14 anos com CDIC progressivamente crescente na fontanela anterior. A análise de imagem e histopatológica confirmou o diagnóstico, e a ressecção cirúrgica foi realizada com sucesso, resultando em excelentes resultados estéticos e funcionais. Os CDICs são benignos, e com diagnóstico adequado e intervenção cirúrgica oportuna, os pacientes experimentam resultados positivos a longo prazo, sem recorrência ou déficits neurológicos. O diagnóstico precoce é essencial para prevenir complicações, como infecção ou deformidades no crânio.
Congenital Inclusion Dermoid Cysts (CIDCs) are rare, benign lesions commonly found over the anterior fontanel. These cysts are typically soft, mobile, painless, and may progressively enlarge, with most cases diagnosed in early childhood. A review of 24 studies highlighted key clinical, laboratory, histopathological, and neuroradiological findings of CIDCs. The average age at diagnosis is 5.3 years. Laboratory analysis often reveals clear or turbid fluid containing keratin and sebaceous material, sometimes resembling cerebrospinal fluid (CSF), which aids in differentiating CIDCs from other cysts. Histopathologically, CIDCs display stratified squamous epithelium with appendages like hair follicles and sebaceous glands, confirming the diagnosis. Neuroimaging reveals cystic lesions with no evidence of intracranial involvement. Surgical excision is the treatment of choice and usually results in favorable outcomes with minimal complications. A case of a 14-year-old female with a progressively enlarging CIDC at the anterior fontanel is presented. Imaging and histopathological analysis confirmed the diagnosis, and surgical resection was performed successfully, leading to excellent cosmetic and functional results. CIDCs are benign and, with proper diagnosis and timely surgical intervention, patients experience positive long-term outcomes without recurrence or neurological deficits. Early diagnosis is essential to prevent complications such as infection or skull deformities.
2. Aquino HB, Miranda CC, Britto CA Fo, Carelli EF, Borges G. Congenital dermoid inclusion cyst over the anterior fontanel: report of three cases. Arq Neuropsiquiatr. 2003;61(2B):448-52. http:// doi.org/10.1590/S0004-282X2003000300022. PMid:12894282.
3. Parízek J, Nĕmecek S, Nĕmecková J, Cernoch Z, Sercl M. Congenital dermoid cysts over the anterior fontanel. Report on 13 cases in Czechoslovak children. Childs Nerv Syst. 1989;5(4):234-7. http:// doi.org/10.1007/BF00271025. PMid:2676162.
4. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372(71):n71. http://doi.org/10.1136/bmj.n71. PMid:33782057.
5. OXFORD CENTRE FOR EVIDENCE-BASED MEDICINE. OCEBM levels of evidence. Oxford: University of Oxford; 2011. Available from: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levelsof-evidence. Accessed: 13/3/2025.
6. Soares CB, Hoga LAK, Peduzzi M, Sangaleti C, Yonekura T, Silva DR. Integrative review: concepts and methods used in nursing. Rev Esc Enferm USP. 2014;48(2):335-45. http://doi.org/10.1590/S00806234201400002000020. PMid:24918895.
7. Souza MT, Silva MD, Carvalho R. Integrative review: what is it?
How to do it? Einstein. 2010;8(1):102-6. http://doi.org/10.1590/s167945082010rw1134.
8. Cao L, Wang Y, Zhao L, Hu X, Cai C. Congenital dermoid inclusion cyst over the anterior fontanel in Chinese children. Clin Dysmorphol. 2020;29(2):81-5. http://doi.org/10.1097/MCD.0000000000000318. PMid:32097174.
9. Fermín S, Fernández-Guerra RA, López-Camacho O, Alvarez R. Congenital dermoid cyst of the anterior fontanel in mestizo-mulatto children. Childs Nerv Syst. 2001;17(6):353-5. http://doi.org/10.1007/ s003810000419. PMid:11417416.
10. Tateshima S, Numoto RT, Abe S, Yasue M, Abe T. Rapidly enlarging dermoid cyst over the anterior fontanel: a case report and review of the literature. Childs Nerv Syst. 2000;16(12):875-8. http://doi.org/10.1007/ s003810000306. PMid:11156305.
11. Glasauer FE, Levy LF, Auchterlonie WC. Congenital inclusion dermoid cyst of the anterior fontanel. J Neurosurg. 1978;48(2):274-8. http://doi.org/10.3171/jns.1978.48.2.0274. PMid:624975.
12. Dadlani R, Ghosal N, Hegde AS. Bregmatic dermoid cyst in a patent anterior fontanelle. J Neurosci Rural Pract. 2013;4(1):105-7. http:// doi.org/10.4103/0976-3147.105645. PMid:23546378.
13. O’Shea GE, Watson VL, Acakpo-Satchivi L. Intraosseous dermoid presenting as an expansile lytic lesion. J Neurol Surg Rep. 2022;83(3):e779. http://doi.org/10.1055/s-0042-1750291. PMid:35832686.
14. Adachi K, Ishii N, Takahashi H, Teramoto A. Congenital dermoid cyst at the anterior fontanelle: neuroimaging before and after fontanelle closure. J Nippon Med Sch. 2012;79(4):291-5. http://doi.org/10.1272/ jnms.79.291. PMid:22976610.
15. Kanamaru K, Waga S. Congenital dermoid cyst of the anterior fontanel in a Japanese infant. Surg Neurol. 1984;21(3):287-90. http:// doi.org/10.1016/0090-3019(84)90204-0. PMid:6695326.
16. Saito M, Takagi T, Ishikawa T. Dermoid cyst of the anterior fontanel: advantage of MRI for the diagnosis. Brain Dev. 1988;10(4):252-5. http:// doi.org/10.1016/S0387-7604(88)80007-X. PMid:3218705.
17. Ojikutu NA, Mordi VP. Congenital inclusion dermoid cyst located over the region of the anterior fontanel in adult Nigerians: report of two cases. J Neurosurg. 1980;52(5):724-7. http://doi.org/10.3171/ jns.1980.52.5.0724. PMid:7373405.
18. Peter JC, Sinclair-Smith C, De Villiers JC. The congenital bregmatic dermoid: an African cyst? Br J Neurosurg. 1992;6(2):107-14. http:// doi.org/10.3109/02688699209002911. PMid:1590963.
19. Peter JC, Sinclair-Smith C, de Villiers JC. Midline dermal sinuses and cysts and their relationship to the central nervous system. Eur J Pediatr Surg. 1991;1(2):73-9. http://doi.org/10.1055/s-2008-1042463. PMid:1854713.
20. Sonntag VK, Waggener JD. Congenital dermoid cyst of the anterior fontanel in a Mexican-American. Surg Neurol. 1980;13(5):371-3. PMid:7385005.
21. Yuasa H, Tokito S, Izumi K, Oyama M. Congenital inclusion dermoid cyst of the anterior fontanel in a Japanese infant: case report. Neurosurgery. 1981;9(1):67-9. http://doi.org/10.1227/00006123198107000-00012. PMid:7279176.
22. Chaudhari AB, Ladapo F, Mordi VP, Choudhury KJ, Naseem A, Obe JA. Congenital inclusion cyst of the subgaleal space. J Neurosurg. 1982;56(4):540-4. http://doi.org/10.3171/jns.1982.56.4.0540. PMid:7062126.
23. Borkar S, Bansal A, Mahapatra A. Congenital dermoid inclusion cyst of anterior fontanelle associated with spinal dysraphism: a case report. Childs Nerv Syst. 2011;27(11):2017-9. http://doi.org/10.1007/ s00381-011-1568-9. PMid:21912941.
24. Sekimoto H, Ishikawa S, Tanaka Y, Seo H, Kuwabara S. Dermoid cyst of the anterior fontanel in an infant. Case report. Neurol Med Chir. 1984;24(11):897-901. http://doi.org/10.2176/nmc.24.897. PMid:6084199.
25. Macedo NT, Ramos VP, Lins C. Cisto dermóide de inclusão da fontanela anterior: relato de um caso. Arq Neuropsiquiatr. 1985;43(4):407-12. http://doi.org/10.1590/S0004-282X1985000400012. PMid:3833143.
26. Oliveira HA. Cisto dermóide de inclusão localizado na região da fontanela anterior no adulto: apresentação de um caso. Arq Neuropsiquiatr. 1989;47(3):375-7. http://doi.org/10.1590/S0004282X1989000300022. PMid:2619618.
27. Tan EC, Takagi T. Congenital inclusion cysts over the anterior fontanel in Japanese children: a study of five cases. Childs Nerv Syst.
1993;9(2):81-3. http://doi.org/10.1007/BF00305312. PMid:8319236.
28. Barahona Soto M, Mejía JE, Vélez SC. Dermoid cyst of the anterior fontanel: case report. Rev Med Hondur. 2010;78(4):191-2. Available from: http://www.bvs.hn/RMH/pdf/2010/pdf/Vol78-4-2010-8.pdf. Accessed: 13/3/2025.
29. Pereira CU, Santos DPS, Machado JC, et al. Congenital dermoid inclusion cyst of the anterior fontanel: report of two cases. Braz Neurosurg. 2000;19(1):32-5. http://doi.org/10.1055/s-0038-1623259.
30. Ponce-Ayala A, Navarro-Garcia de Llano JP, Degollado-Garcia J, Hernández-Álvarez N, Mendizabal-Guerra R. Anterior Fontanelle dermoid cyst: surgical technique. Cureus. 2021;13(7):e16348. http:// doi.org/10.7759/cureus.16348. PMid:34395129.
31. Rinna C, Reale G, Calafati V, Calvani F, Ungari C. Dermoid cyst: unusual localization. J Craniofac Surg. 2012;23(5):e392-4. http:// doi.org/10.1097/SCS.0b013e31825ab1e1. PMid:22976680.
1Faculdade de Medicina de Marília – FAMEMA, Marília, SP, Brazil.
2Department of Neurosurgery, Universidade Estadual de Campinas – UNICAMP, Campinas, SP, Brazil.
3Department of Neurosurgery, Hospital das Clínicas, Faculdade de Medicina de Marília – FAMEMA, Marília, SP, Brazil.
Received Mar 13, 2025
Accepted Apr 17, 2025
