Related Experiment Video
Updated: May 29, 2026
Construction and Evaluation of a Murine Calvarial Osteolysis Model by Exposure to CoCrMo Particles in Aseptic Loosening
Published on: February 17, 2018
Progressive osteolytic calvarial lesions in children after minor head injury
Elvis J Hermann1, Bujung Hong, Almuth Brandis
1Department of Neurosurgery, Hannover Medical School, Hannover, Germany. Hermann.Elvis@mh-hannover.de
Insights
Progressive osteolytic skull lesions in children can rarely develop after mild head trauma. These lesions may resolve spontaneously or require surgical intervention for diagnosis and treatment.
Area of Science:
- Pediatric Radiology
- Pediatric Neurosurgery
- Pediatric Pathology
Background:
- Osteolytic skull lesions in children present a wide differential diagnosis.
- Progressive osteolysis of the skull following head trauma is uncommon and poorly understood.
Observation:
- A review identified 10 children with osteolytic skull lesions; 2 had preceding mild head trauma without fracture.
- Imaging (CT/MRI) revealed circumscribed progressive cranial osteolysis in these cases.
- Literature review identified 3 additional similar cases.
Findings:
- Lesions involved the diploe and outer skull table, or both inner and outer tables.
- Pathology in one case showed organized hemorrhage with papillary endothelial hyperplasia.
- Surgical resection or a conservative approach were employed, with spontaneous reossification noted in one instance.
Implications:
- Mild head trauma can precipitate progressive osteolytic calvarial lesions in pediatric patients.
- These lesions may stem from hematomas triggering an inflammatory response.
- Differential diagnosis should include post-traumatic osteolysis, with options for surgical or conservative management.
Objective:
Osteolytic lesions of the skull in children have a broad differential diagnosis including congenital, inflammatory and neoplastic lesions. Progressive osteolysis of the skull secondary to head trauma is rare and has been poorly characterized.
Methods:
The pediatric database at our hospital was screened for children with osteolytic lesions who had a previous mild head injury without fracture or dural tears. We identified 2 children with circumscribed progressive cranial osteolysis after minor head trauma detected by CT and MRI scans. Three additional cases were found in a review of the published literature.
Results:
Ten children with an osteolytic skull lesion treated between January 1998 and February 2008 were identified in our pediatric database. In 2 children there was evidence of previous mild head injury without a skull fracture. Trauma had occurred 7 and 2 months prior to presentation, respectively. The inner table of the skull was intact in both cases. In 1 case, surgery was performed, and in the other case, a wait-and-see strategy was adopted. Pathological examination in case 1 revealed an organized hemorrhage with focal papillary endothelial hyperplasia.
Conclusions:
Progressive osteolytic calvarial lesions may occur in both infants and adolescents after mild head injury. They involve either only the diploe and outer table of the skull or both the inner and outer tables. These lesions might be due to intradiploic or subgaleal hematomas triggering an inflammatory process. While surgical resection can be considered to confirm a histopathological diagnosis and to exclude other diagnoses, spontaneous reossification is possible.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the procedure...
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:25Secondary Spinal Cord Injury llI: Pathophysiology
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...