Reversal of increased intracranial pressure with removal of a torcular epidermoid: Case report

cause of increased intracranial pressure, but it has been documented rarely . We present a case of obstruction of the torcula by a slow-growing epiderm oid. The tumor caused increased intracranial pressure, which was relieved w hen it was excised. in addition, the torcular epidermoid is associated with a bifid straight sinus. CLINICAL PRESENTATION: A 35-year-old man presented with a headache and a lu mp on the back of the head. Physical examination revealed a firm, bony lesi on approximately 4 x 4 cm in size. Lumbar puncture demonstrated an intraspi nal pressure of 39 cm H2O. Neuroradiological studies revealed an epidermoid that compressed and almost completely occluded the torcula. INTERVENTION: After the tumor was resected, the intraspinal pressure decrea sed to 19 cm H2O and remained stable 6 months later. CONCLUSION: Pure venous obstruction causes increased intracranial pressure. Removal of the obstruction relieves the intracranial hypertension. In addi tion, computed tomographic venography is a safe and easy method of document ing torcular anatomy, and it was useful in the follow-up of this patient. C omputed tomographic venography can demonstrate a double straight sinus, whi ch is a congenital variant that may be associated with the epidermoid.