Spontaneous Rupture of a Fourth Ventricular Mature Teratoma Presenting with Aseptic Meningitis in a 10-Year-Old: A Rare Case from a Rural Kenyan Hospital

A Rare Case from Rural Kenya

Abstract

Background: Mature teratomas of the central nervous system are rare congenital germ cell tumours, accounting for <0.5% of all intracranial neoplasms. Spontaneous rupture with dissemination of fatty material into the ventricles and subarachnoid spaces is uncommon, particularly from the fourth ventricle, and may precipitate aseptic meningitis, complicating diagnosis and management. Case: We report a 10-year-old girl with progressively worsening headaches, recurrent vomiting, and new-onset generalised tonic–clonic seizures. Neurological examination showed mild truncal ataxia without focal motor deficits. Cranial computed tomography (CT) demonstrated a heterogeneous fourth ventricular mass with fat–fluid levels and fat droplets layering the ventricular system and basal cisterns. Intervention: The patient underwent telovelar microsurgical gross total resection (GTR). The procedure was uneventful, and early postoperative contrast-enhanced CT confirmed complete excision with patent cerebrospinal fluid pathways. No adjuvant chemotherapy or radiotherapy was given, as histopathology confirmed a mature teratoma. Outcome: The postoperative course was uncomplicated. At 3- and 6-month follow-up, the child remained neurologically intact and free of headaches, seizures, and other symptoms, with no radiological evidence of residual or recurrent tumour. Long-term follow-up with serial clinical and imaging assessments is planned for at least three years to monitor for recurrence or delayed complications. Conclusion: Telovelar gross total resection alone may achieve excellent outcomes in ruptured fourth ventricular mature teratomas. This case, to our knowledge the first report of spontaneous rupture of such a lesion from a rural African neurosurgical centre, underscores the growing capacity for complex neurosurgical care in resource-limited settings.