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Pediatric Cranial Vault Lesions: A Tailored Approach According to Bony Involvement
Arianna Barbotti1, Ignazio G Vetrano1,2, Cecilia Casali1
1Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy.
Insights
Early surgical removal of pediatric cranial vault lesions is recommended for complete tumor resection and diagnosis. Minimally invasive techniques are preferred, with autologous bone grafting for larger defects.
Area of Science:
- Pediatric Neurosurgery
- Surgical Oncology
- Pediatric Pathology
Background:
- Cranial vault lesions are common in children, with dermoid and epidermoid cysts being most frequent.
- Management is debated due to slow growth, but early resection prevents complications and aids diagnosis.
- Histological diagnosis can reveal links to systemic diseases.
Purpose of the Study:
- To evaluate the surgical management of pediatric cranial vault tumors.
- To analyze outcomes of early resection and reconstructive techniques.
- To correlate histopathology with clinical presentation and treatment.
Main Methods:
- Retrospective study of 88 children treated surgically for cranial vault tumors (Jan 2011-Apr 2023).
- Data collected: age, gender, symptoms, comorbidities, lesion characteristics, surgical approach, histopathology, recurrence.
- Surgical techniques included simple skin incisions, bone cement cranioplasty, and autologous bone grafting.
Main Results:
- Most common lesions: dermoid cysts, myofibroma, Langerhans cell histiocytosis.
- Gross total resection achieved in 64 cases; 13 required bone cement cranioplasty.
- 11 patients with large lesions (>2cm) and full skull erosion underwent autologous bone grafting.
Conclusions:
- Early resection of pediatric cranial vault lesions is recommended for complete removal and definitive diagnosis.
- Minimally invasive surgery is feasible for most lesions.
- Cranioplasty with autologous bone is the preferred technique for large defects with full skull erosion.
Background:
Cranial vault lesions are common in children, with dermoid and epidermoid cysts being the most frequent. Management is debated due to their slow growth, but early resection can prevent complications and provide a definitive histological diagnosis, which is sometimes linked to systemic diseases.
Methods:
A retrospective study of children treated surgically for cranial vault tumors from January 2011 to April 2023 was conducted. The data collected included age, gender, symptoms, comorbidities, lesion location, radiological features, surgical techniques, histopathology, and recurrence rates.
Results:
Eighty-eight children (mean age: 3.5 years, mean tumor size: 1.21 cm) underwent surgery. The most common locations were the frontal and occipital bones. The main diagnoses were dermoid cysts, myofibroma, and Langerhans cell histiocytosis. Gross total resection was achieved in 64 cases with simple skin incisions. In 13 cases, small cranioplasties with bone cement were used. Craniotomy and cranioplasty with autologous bone grafting were performed for 11 patients with lesions larger than 2 cm and full skull thickness erosion.
Conclusions:
Early resection is recommended for complete removal with minimally invasive surgery and to ensure histological diagnosis. For lesions larger than 2 cm with full skull erosion, cranioplasty with autologous bone is the preferred technique.
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