Lesions of the calvaria: surgical experience with 42 patients

Lesions of the calvaria (cranial vault), whether benign or malignant, are rare, and the number that require surgical attention is very limited. During a 13-year period, 42 patients ranging in age from 13 to 82 years were treated surgically at our institution for lesions involving primarily the calvaria. The patients were found to have 16 benign lesions, 21 malignant lesions, and 5 pathologically ill-defined lesions. At last follow-up, 23 patients were still alive.

Criteria for choosing surgery as the preferred therapeutic modality included (a) uncertain diagnosis; (b) benign lesions with a high probability of total removal; 3) malignant lesions that represented the only residue of a systemic malignancy that was in remission; or (d) lesions that were rapidly enlarging, were causing significant symptoms, or were unresponsive to radiation or chemotherapy.

Preoperative needle biopsy was useful for some patients in establishing a definitive diagnosis and in providing the basis for the most effective treatment strategy. Most lesions were treated with either craniectomy alone (n = 16) or with craniectomy and cranioplasty (n = 26). Six of the 42 patients had postoperative complications. There was no operative mortality.

This review of a series of patients with calvarial lesions provides an outline of the overall diagnostic workup and management of this unique patient population.