Operative treatment of cranial vault tumors in pediatric patients

Tumors of the cranial vault in pediatric patients are presented as a subcutaneous mass of variable firmness, painless and not removable from the underlying bone. Parents most often detect a gradual increase in size. The diagnostic procedure includes clinical examination, skull x- rays, and brain CT with bone window. If intracranial involvement is suspected, MR is indicated for more accurate assessment of possible intracranial propagation. In a group of 30 patients with suspected cranial vault tumors, diagnostic and clinical examinations were performed to exclude non-neoplastic masses in 12 patients (reactive ossifications at the site of previous skull fracture, calcified cephalic haematoma, subcutaneous granuloma and calcified remnants of subgaleal haematomas). In the remaining 18 patients with diagnosed cranial vault tumors (12 female and 6 male gender, mean age 4.1 years, range from 3 months to 12 years) radical operative resection was performed. Patho-histological findings showed a dermoid cyst in 9 patients, eozinophilic granuloma in 4 patients, osteoma in 3 patients, non-specific granuloma in one patient, intraosseal haemangioma in one patient. In patients older than 3 years, larger postoperative cranial defects were covered with alloplastic material palacos. In one 3-year-old patient a postoperative frontal bone defect was covered with bone auto-transplant. Additional oncologic treatment was performed in all patients with eozinophilic granuloma. One of them had proven multiple skeletal changes. One patient with multiple cranial vault metastases from a leg osteosarcoma was not operated due to the unfavourable clinical condition. During the 3 years of follow-up, there have been no local tumor recurrences.