AB056. Management of a rare case of adult intracranial large temporal mature teratoma in limited neurosurgical care settings: a case report

Background: Teratoma is a neoplasm constitutes non germinomatous germ cell tumors, that composed of different tissue types consist of ectoderm, endoderm, and mesoderm. Intracranial teratomas occurs primarily in paediatrics group, it is very rare tumors of adults, account for only 0.3–0.5% of all primary brain tumors and usually occurs and involve midline structures. Teratomas are classified into three main groups: mature, immature, and teratomas with malignant transformation. We reported an uncommon case of mature large intracranial teratoma in an adult patient.

Case Description: We presented our case as a descriptive report in accordance with the CARE case report guideline. A 54-year-old woman came to Neurosurgery Outpatient Clinic with a history of chronic progressive headache since 5 years ago, along with blurred vision of the right eye and history of seizure, and slight hemiparesis. There is no history of other tumor of the patient and her family. A non-contrast head magnetic resonance imaging (MRI) revealed extra-axial mixed intensity mass at right temporal base extend to frontal and parietal with size 7.28 cm × 7.23 cm × 7.48 cm. Near total tumor removal (95%) was performed through extended pterional approach, we left inferior capsule attached to the M2 artery and dural base. Macroscopically, the tumor consists of mixed consistency, with some tumor tissue like hair and bone. Histopathological results conclude a mature teratoma, with findings of lamellated keratin, bone trabeculae, fat, and sebaceous glands. Postoperatively, patient had slight worsening of hemiparesis, with post operative computed tomography (CT) scan reveals a near complete tumor removal. After discharged, due to financial and distance to neurosurgical center reasons, the patient was unable to go to the hospital, and was lost to follow-up.

Conclusions: We reported a rare case of intracranial large temporal mature teratoma of an adult. Despite the better prognosis of this tumor, patients should be followed up for a long period, as any malignant tumor, new or recurrent teratomas might arise. In our province, geographically we have only three neurosurgeons, all located in Kupang City, Timor Island, among total 42 inhabited islands. Low socioeconomic status, and financial problems usually become problems ended in lost to follow up. Further strategy to improve neurosurgical care is needed.

Keywords: Adult intracranial teratoma; rare intracranial tumor; large tumor; limited neurosurgical services; case report