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  • Pediatric Skull Lesions

    Final Number:

    Yasser Jeelani MD; Stephanie L Da Silva BA; Grace J Young BA; Mark D. Krieger MD; J. Gordon McComb MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Palpable skull lesions encompass a diverse group of histological entities. A review of these masses at one institution was undertaken for further insights.

    Methods: An IRB approved retrospective review was undertaken to identify all patients who underwent surgical excision of a skull mass between 1997 & 2012.

    Results: A total of 279 patients were identified, with no sex predilection (Male:140, Female:139). Non-malignant lesions totaled 264/279(95%) with dermoid cysts 142(52%) and Langerhan Cell Histiocytosis (LCH) 31(11%) being the most common. Malignant lesions accounted for 15/279(5%) and consisted of 4 primary malignancies and 11 metastatic lesions and included a diverse histology. Pain to palpation was noted in 38/279 (14%), 35 of which were benign with LCH accounting for 17. Mean age at diagnosis for malignant lesions was not significantly different from those non-malignant (59 and 69 months, respectively; p=0.1). No significant complication form the surgery was recorded in any patient. At a mean follow-up interval of 17 months, recurrence was encountered in 8/15 malignant lesions and 5/264 benign masses, usually at the original site. Only 42/279 (15%) had some form of preoperative imaging.

    Conclusions: The overwhelming majority of skull masses can be completely and safely excised with preoperative imaging not needed for obvious lesions such as dermoid cysts.

    Patient Care: This study aims to evaluate the safety and effectiveness of primary resection of skull lesions followed by histological evaluation in the treatment of pediatric skull lesions. The over reliance on imaging in altering the mode of treatment is discouraged in an effort to improve economization of healthcare resources.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Develop a rough idea of the histological distribution of head lumps 2) Discuss whether imaging is indicated for all asymptomatic, non-traumatic head 'lumps' 3) Draw inferences for when to expect recurrences.

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