gms | German Medical Science

Objective: Osteolytic lesions of the skull in children have a broad differential diagnosis including congenital, inflammatory and neoplastic lesions. The occurence of progressive osteolysis of the skull secondary to head trauma is nearly unknown.

Methods: We present 4 cases of localized progressive cranial osteolysis detected after minor head trauma. All children had CT and MRI scans. Operative resection of the osteolytic lesion was performed in three cases.

Results: There were two girls and two boys. The mean age was 14 years with a range between 16 months and 16 years. All children had a single osteolytic lesion of the skull. In two cases the lamina interna was not involved in the osteolytic process. One of them had no surgery and is still in follow-up after spontaneous regression of the skull osteolysis. In 2 cases with complete bone involvement, cranioplasty was required. The localization was parietal in three cases and frontal in one case. Pathological examination revealed a cavernous hemangioma, fibrous dysplasia and an organized hemorrhage with focal papillary endothelial hyperplasia, respectively. Postoperatively, all patients were asymptomatic. No further treatment was necessary.

Conclusions: In general, it is advisable to resect progressive osteolytic lesions of the skull following mild head trauma to confirm the histopathological diagnosis and to stop progressive osteolysis. In cases with focal inflammatory changes, however, spontaneous regression may also occur. Due to the rarity of such lesions their development and natural course remain to be fully understood and classified.