Surgical resection of osteolytic calvarial lesions: Clinicopathological features
Introduction
Focal lesions of the calvarium may originate primarily from bony structures or they may be secondary to invasion from adjacent skin- or brain-based lesions into bony structures. They might be found in any layer of the calvarium. Overall, such lesions are infrequent and they present either as sclerotic or lytic pathologies [1]. Gibson et al. reported 138 cases of primary skull lesions, nineteen of them in children, during a 25-year period [2]. The most common histopathological findings were epidermoid cyst and Langerhans-cell histiocytosis. Stark has found 12 skull metastases among 38 patients who underwent surgery for a skull lesion during a 10-year period [3]. Likewise, Wecht et al. have identified 42 patients with primary calvarial lesions during a 13-year period [4].
In previously reported cases, the extent of treatment of calvarial lesions varied widely, from conservative management to complete resection. Gibson and Prayson [2] suggested complete resection of all primary skull lesions to avoid recurrence. Wecht and Sawaya [4] indicated surgical resection for diagnosis, cosmetics, symptomatic relief or potential cure. Stark et al. [3] suggested surgical treatment only in case of presence of neurological deficits, massive destruction of bone with dura infiltration, painful mass, solitary metastasis and to confirm the diagnosis. Biopsy was considered useful to plan the surgery regarding the extension and possible additional technical support [4] or in case of poor general condition [3]. Furthermore, observational follow-up for a limited period of time are also recommended, if clinical and radiographic work up, seems to harbour a benign lesion [4].
Thus, no standardized treatment algorithm for osteolytic calvarial lesions has been suggested.
Here, we review the clinicopathologic features and outcome after surgery for osteolytic calvarial lesions during a 10-year period in our department.
Section snippets
Material and methods
We retrospectively reviewed the medical records of 36 patients who underwent surgical resection of an osteolytic calvarial lesion at the Department of Neurosurgery, Hannover Medical School, between January 1998 and February 2008. The charts with the clinical data (age, sex, preoperative symptoms and signs, concomitant diseases, recurrence of tumor), pre- and postoperative imaging studies, and operative notes (extent of resection, surgical technique) were analyzed. Complete resection was defined
Results
Thirty-six osteolytic calvarial lesions were identified in 20 men (56%) and 16 women (44%). The mean age at the time of diagnosis was 37 years (range, 10 months to 81 years). Ten patients (28%) were younger than 15 years. The lesions were located in the occipital (n = 9), frontal (n = 9), parietal (n = 14), or temporal (n = 4) calvarium (Table 1). Fifteen patients presented with only minor symptoms, such as a painless skull mass or soft tissue enlargement. In 5 cases, the osteolytic lesions were
Discussion
Osteolytic calvarial lesions are relatively infrequent. They may be either asymptomatic, or they may present with unspecific symptoms or with local pain [2], [3], [4]. Our retrospective review of all surgically treated patients in our department during a 10-year period identified 32 cases with osteolytic calvarial lesions. Over one fourth of the lesions (28.6%) were found in the pediatric population. Possibly the actual incidence of such lesions is higher than reported, since they may be
Conclusions
Osteolytic calvarial lesions are found in any age group. Multi-modal imaging with CT and MR, combining information on bone and soft tissue, offers a good perspective for the surgical planning. Histopathological examination may reveal various diagnoses, and in rare cases it does not correspond to the known primary tumor but may reveal another malignancy. No complication was noted following surgical resection. Regarding the unknown dignity of the lesion at surgery and the low surgical morbidity,
Disclosure of interests
The authors have no potential conflicts of interest to disclose.
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