Article
Calvarial lesions – overview and neurosurgical management
Kalottenläsionen – Übersicht und neurochirurgisches Management
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Authors
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Isabella Nasi-Kordhishti
- UKT Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Marcos Tatagiba
- UKT Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Florian Ebner
- UKT Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: A variety of different diseases can cause calvarial lesions. Calvarian lesions are divided in primary lesions, originating in the bone and secondary lesions infiltrating the bone. The lesions can be palpable on the skin, cause local pain and paraesthesia and, depending on the location, neurological deficits can also occur. The aim of this research is to present an overview of different calvarial lesions as well as their pre-, intra- and postoperative course.
Methods: We examined the charts of all patients (children and adults) who underwent surgery on a calvarial lesion in our department between 2004 and 2017 (n=133). Retrospectively, the pre-, intra- and postoperative data were analyzed with morphological and histological findings. Included were lesions of the calvarium and the orbit, excluded were skull base tumors.
Results: Pain (n=61), swelling (n=85), cosmetically disturbing (n=58) and neurological deficits (n=22) were the main complaints. Intraoperatively, the majority of lesions originated from the bone (n=120). 77 were limited in the bone, the remainder showed an infiltrating growth in the adjacent tissue. Depending on the clinical disorder, the location and suspected diagnosis, a biopsy (n=8), extended (n=18) or complete resection (n=107) was performed. Intraoperative complications such as major bleeding occurred in 5% of cases; a sinus injury in 2%. There were a variety of different histological lesions. Histiocytosis (n=20), meningiomas (n=20), metastases (n=19), osteomas (n=16) and dermoid/epidermoid cysts (n=16) were the most common. Fibrous dysplasia (n=6) and intraosseous hemangiomas (n=9) were less common; other rare lesions comprised aneurysmal bone cyst, aspergillosis, plasmocytoma, Paget’s disease. 28 patients underwent further treatment.
Conclusion: In calvarial lesions imaging gives a hint, but the diagnosis can be only confirmed by histological examination. An important role of imaging is that the assessment of the degree of infiltration into adjacent tissues. The surgical strategy depends on the clinical disorders, the location and the suspected diagnosis. A further treatment should be initiated according to the histological findings.
