Background/Aims: Tumors of the cranial vault occur at every age of childhood. Although they are mostly benign lesions, their symptomatology is variable and requires extended diagnostics. The choice of therapeutic strategy strongly depends on histopathological diagnosis, and therefore surgical excision is the elective treatment in such cases. Despite several published papers, the literature still lacks reliable clinical characteristics regarding this heterogeneous group of lesions in pediatric patients. Methods: We present a series of 100 children (55 male, 45 female) with scalp and cranial vault masses (average age: 3.6 years; range: 1 month to 17 years). Eighty-three (83%) patients underwent surgical excision. Demographic data, clinical presentation, diagnostic studies, choice of therapy, and the results of treatment were evaluated. Results: All removed tumors were benign pathologies: pilar cysts (30%), epidermoid/dermoid cysts (21%), vascular malformations (11%), inflammatory tumors (5%), and dysraphic remnants (2%). However, underlying bone destruction was observed in 61% of cases. Cranial extension occurred in 34%. Recurrence was noted in 1 case. Conclusions: Cranial vault tumors are characterized by constant growth and may penetrate the cranial cavity. Delayed surgery increases the risk of intracranial complications. Surgical problems include inappropriate planning, higher risk of intraoperative bleeding, and the need for subsequent cranioplasty.

1.
Cummings TJ, George TM, Fuchs HE, McLendon RE: The pathology of extracranial scalp and skull masses in children. Clin Neuropathol 2004;23:34-43.
2.
Shahabi S, Busine A: Prenatal diagnosis of an epidermal scalp cyst simulating an encephalocoele. Prenat Diagn 1998;18:373-377.
3.
Bae JY, Seong WJ, Lee TH, Park IS: Prenatal diagnosis of scalp cyst with spontaneous regression. J Clin Ultrasound 2011;39:484-486.
4.
Eras MA, Tari R, Ozturk G, Oz B, Bilge T: Intraosseous meningioma mimicking osteosarcoma in an adolescent: a case report. Turk Neurosurg 2011;21:663-665.
5.
Hadley C, Gressot LV, Patel AJ, et al: Osteosarcoma of the cranial vault and skull base in pediatric patients. J Neurosurg Pediatr 2014;13:380-387.
6.
Cigit I, Gjurasin M, Vrtar Z, Jakobovic J, Butkovic D, Kust S: Operative treatment of cranial vault tumors in pediatric patients. Paediatr Croatica 2005;49:223-226.
7.
Kestle JRW: Tumors of the cranial vault in children; in Tonn J-C, Westphal M, Rutka JT (eds): Oncology of CNS Tumors, ed 2. Berlin/Heidelberg, Springer, 2010, pp 629-635.
8.
Yoon SH, Park SH: A study of 77 cases of surgically excised scalp and skull masses in pediatric patients. Childs Nerv Syst 2008;24:459-465.
9.
Martínez-Lage JF, Capel A, Costa TR, Perez-Espejo MA, Poza M: The child with a mass on its head: diagnostic and surgical strategies. Childs Nerv Syst 1992;8:247-252.
10.
Nagasawa D, Yew A, Safaee M, et al: Clinical characteristics and diagnostic imaging of epidermoid tumors. J Clin Neurosci 2011;18:1158-1162.
11.
Martínez-Lage JF, Torroba MA, Cuartero Pérez B, Almagro MJ, Lopez Lopez-Guerrero A, de la Rosa P: Cavernous hemangiomas of the cranial vault in infants: a case-based update. Childs Nerv Syst 2010;26:861-865.
12.
Shah HC, Mittal DH, Shah JK: Intravascular papillary endothelial hyperplasia (Masson's tumor) of the scalp with intracranial extension. J Pediatr Neurosci 2014;9:260-262.
13.
Lewoczko KB, Rohman GT, LeSueur JR, Stocks RM, Thompson JW: Head and neck manifestations of Langerhan's cell histiocytosis in children: a 46-year experience. Int J Pediatr Otorhinolaryngol 2014;78:1874-1876.
14.
Yang CC, Chen YA, Tsai YL, Shih IH, Chen W: Neoplastic skin lesions of the scalp in children: a retrospective study of 265 cases in Taiwan. Eur J Dermatol 2014;24:70-75.
15.
Pannell BW, Hendrick EB, Hoffman HJ, Humphreys RP: Dermoid cysts of the anterior fontanelle. Neurosurgery 1982;10:317-323.
16.
Willatt JM, Quaghebeur G: Calvarial masses of infants and children. A radiological approach. Clin Radiol 2004;59:474-486.
17.
Massimi L, De Bonis P, Esposito G, et al: Vertex scalp mass as presenting sign of a complex intracranial vascular malformation. J Neurosurg Pediatr 2009;3:307-310.
18.
Holthusen W, Lassrich MA, Steiner C: Epidermoids and dermoids of the calvarian bones in early childhood: their behaviour in the growing skull. Pediatr Radiol 1983;13:189-194.
19.
Wood J, Couture D, David LR: Midline dermoid cyst resulting in frontal bone erosion. J Craniofac Surg 2012;23:131-134.
20.
Ruge JR, Tomita T, Naidich TP, Hahn YS, McLone DG: Scalp and calvarial masses of infants and children. Neurosurgery 1988;22:1037-1042.
21.
Hseu A, Watters K, Perez-Atayde A, Silvera VM, Rahbar R: Pediatric nodular fasciitis in the head and neck: evaluation and management. JAMA Otolaryngol Head Neck Surg 2015;141:54-59.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.