Congenital Dermoid Cyst of the Anterior Fontanelle in Turkish Children-Four Case Reports-

Pediatric Cranial Vault Lesions: A Tailored Approach According to Bony Involvement

BACKGROUND

Cranial vault lesions are common in children, with dermoid and epidermoid cysts being the most frequent. Management is debated due to their slow growth, but early resection can prevent complications and provide a definitive histological diagnosis, which is sometimes linked to systemic diseases.

METHODS

A retrospective study of children treated surgically for cranial vault tumors from January 2011 to April 2023 was conducted. The data collected included age, gender, symptoms, comorbidities, lesion location, radiological features, surgical techniques, histopathology, and recurrence rates.

RESULTS

Eighty-eight children (mean age: 3.5 years, mean tumor size: 1.21 cm) underwent surgery. The most common locations were the frontal and occipital bones. The main diagnoses were dermoid cysts, myofibroma, and Langerhans cell histiocytosis. Gross total resection was achieved in 64 cases with simple skin incisions. In 13 cases, small cranioplasties with bone cement were used. Craniotomy and cranioplasty with autologous bone grafting were performed for 11 patients with lesions larger than 2 cm and full skull thickness erosion.

CONCLUSIONS

Early resection is recommended for complete removal with minimally invasive surgery and to ensure histological diagnosis. For lesions larger than 2 cm with full skull erosion, cranioplasty with autologous bone is the preferred technique.

Adelola Adeyole (1935-2021): Early descriptor of congenital dermoid or epidermoid inclusion cyst over the anterior fontanelle and below the galea aponeurotica

The author wished to detail the life and contributions of Dr. Adelola Adeloye, MBBS, MS, FWCS, FRCS, FACS, FRCP, in hope to pay homage to this giant in Global Neurosurgery. Dr. Adelola Adeloye was born on July 18, 1935 in Illesa, Osun State, present-day South-West Nigeria. The Adeloye-Odeku disease is an eponym for a congenital dermoid or epidermoid inclusion cyst (CDIC/CEDIC) over the anterior fontanelle and below the galea aponeurotica. In 1971, Adeloye and Odeku first described these cysts in 18 Nigerian patients. While overall rare and predominantly noted in children, the Adeloye-Odeku disease has been found to impact adults too. In terms of rarity, CDICs make up 0.1-0.5% of cranial tumors and 0.2% of inclusion cysts. CDICs can be distinguished from CEDICs through histopathology as dermoid cysts may contain hair follicles, sweat, sebaceous glands, and teeth, whereas CEDICs usually are only composed of keratinized debris and epidermal tissue. Assumed first to be an African cyst, cases of the Adeloye-Odeku disease were subsequently reported in other ethnic populations: Turkish, Czechs, Slovaks, Chinese, Japanese, Canadians, Saudi Arabians, Indians, Caucasians, Bangladeshis, Spaniards, and Brazilians.

Transillumination of an Anterior Fontanelle Dermoid Cyst

Dermoid cysts are slowly growing benign lesions of ectodermal tissue that often occur in the anterior fontanelle. Clinicians often rely on a negative transillumination test to begin the process of correctly diagnosing a dermoid cyst. However, here the authors present a case of a 7-month-old girl who presents with a transilluminating dermoid cyst.

Anterior Fontanelle Dermoid Cyst: Surgical Technique

Dermoid cysts are benign congenital lesions that usually appear on the surface of the skull, mainly on the anterior fontanelle. Diagnosis is usually made in the first months of life by physical examination and imaging studies such as CT, MRI, or ultra sound (US) Doppler. It is important to distinguish it from other similar lesions that represent greater surgical complexity, morbidity, and mortality. In this work, we show the principle differential diagnoses, the diagnostic approach, and the surgical technique used in the resection of the dermoid cyst located over the anterior fontanelle.

Congenital dermoid inclusion cyst over the anterior fontanel in Chinese children

Congenital dermoid inclusion cyst (CDIC) over the anterior fontanel is a rare and benign tumor. This study reports nine Chinese cases (three females and six males) with CDIC over the anterior fontanel. The clinical manifestations and imaging were analyzed retrospectively. Surgical resection was undertaken in all cases. The diagnosis of CDIC over the anterior fontanel was confirmed by histological examination. The cysts were all noticed soon after birth and enlarged gradually. They were soft, nontender with a sessile base without inflammatory signs and breaking. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed soft tissue mass over the anterior fontanel without intracranial extensions. The histopathological examination displayed stratified squamous epithelium with skin appendages. There were no complications or recurrence after operation during a follow-up for one year. CDIC over the anterior fontanel is a benign tumor. Imaging is recommended preoperatively to aid differential diagnosis. The main management is total excision with good prognosis.

Scalloping Characteristics in a Patient with Extra-Cranial Hemangioma

Infantile hemangiomas are the most common benign tumors of infancy and childhood with a reported incidence of 4% to 10% in infants. We report of a 9 year-old male child with a history of progressively increasing swelling over the right eyebrow region. The lesion was present since childhood; however, it increased in in size over the previous 3-4 months. The CT scan showed scalloping over the right supra-orbital ridge with an intact bone. The child underwent total excision of the lesion. A characteristic scalloping seen on imaging (depression in the outer or inner table of the skull) can help differentiate lesions of extracranial and intracranial origins.

Rare case of anterior fontanelle epidermoid/dermoid

Anterior fontanelle cysts are rare in occurrence in the area of anterior fontanelle. Most of them are dermoid cysts. Epidermoid cysts are even rarer to be seen. Authors are reporting a rare case of epidermoid cyst located in anterior fontanelle along with two cases of dermoid in this area. Magnetic resonance imaging revealed that a cystic swelling was present in the anterior fontanelle area. Few cases have been reported in the literature. Present case of epidermoid is analysed and available literature is reviewed.

Dermoid cysts: a report of 75 pediatric patients

Dermoid cysts (DCs) are benign cutaneous tumors that tend to persist and grow. The aim of this study was to examine the clinicopathologic features of congenital DCs. We present a case series of 75 children with a clinicopathologic diagnosis of DC. Seventy-two cysts were located on the head, one on the neck, and two on the trunk. Six cysts were located along the midline. Eight patients had symptoms other than changes in cyst size. Imaging studies were performed on 15 patients. Surgical excision was the primary treatment in all 75 cases. Neurosurgery and ophthalmology services were involved in the care of some patients. Histopathologic studies reported a foreign body giant cell reaction in 17 of the cysts. No recurrence was documented. DCs can remain stable for years, but they can become symptomatic as a result of enlargement and rupture or, more rarely, as a result of extension into surrounding tissues. Physicians should be aware that certain locations have a higher risk of DC extension, and adequate diagnostic investigations should be performed before their complete resection.

Scalp dermoids: a review of their anatomy, diagnosis, and treatment

BACKGROUND

Scalp dermoid cysts are subcutaneous sacs lined with a stratified squamous epithelium containing developmentally mature ectodermal tissues, including skin, hair follicles, sweat glands, and sebaceous glands.

METHODS

Because they consist of developmentally mature tissues, scalp dermoid cysts are generally benign. Typically, cysts are limited to an extracranial location, and management generally involves simple surgical resection.

DISCUSSION

Because of the potential for intracranial and/or intradural extension associated with some scalp dermoids, however, a comprehensive clinical evaluation incorporating MRI and CT imaging is included in the diagnostic process.