A massive right Sylvian fissure epidermoid cyst presented with progressive truncal ataxia and hemiparesis: a case report

Introduction: Intracranial epidermoid cysts are rare congenital lesions that can occur in the suprasellar region, the cerebellopontine angle, the basilar-pontine fossa, the ventricular system, and, only rarely, the Sylvian fissure. Case presentation: We present the case of a 41 year-old male patient experiencing headache, nausea, vomiting, confusion, truncal ataxia, seizures, and left hemiparesis, who was found to have a right Sylvian fissure epidermoid cyst. Clinical discussion: A craniotomy was performed, and step-by-step intraoperative guidance was illustrated. Postoperative follow-up showed a normal neurological examination and resolution of the previously mentioned symptoms (seizures, headaches, nausea, vomiting, ataxia, confusion, left-sided weakness). A comparison with other cases of Sylvian fissure epidermoid cysts was conducted. Conclusion: An epidermoid cyst, although a benign entity, can present with serious symptoms when occurring in the Sylvian fissure, affecting patients’ quality of life and necessitating early diagnosis and intervention.