A retrospective study comprising 228 cases of pediatric scalp and skull lesions

Ultrasound as a standalone tool for the management of pediatric calvarial dermoid cysts

PURPOSE

Calvarial dermoid and epidermoid cysts are benign lesions common in pediatric neurosurgery. Diagnosis is primarily clinical, with frequent but inconsistent use of imaging. Dermoids have been shown to possess distinct sonographic features, but ultrasound (US) remains underutilized in their management. The purpose of this study is to investigate the independent reliability of US in managing pediatric calvarial dermoids and distinguishing them from other calvarial lesions.

METHODS

A retrospective review of consecutive patients ≤ 21 years of age with surgically resected calvarial masses between 2017-2024 was performed. Demographic, clinical, and imaging data were analyzed. Pearson chi-squared tests were used for comparison of categorical variables and a binomial linear model was generated controlling for age, lesion tenderness, growth, and suture location.

RESULTS

Fifty-nine patients with 61 lesions (31 in females; median age 13 months) were included. Dermoids were more common in younger patients (median age 12 months), along suture lines, and were less likely to present with tenderness (p < 0.001) or rapid growth (p = 0.003). Ultrasound was used in 83% of cases and was the sole imaging modality in 33%. On multivariate analysis, suture location was a significant positive predictor of a dermoid diagnosis (OR = 8.08, 95% CI = 1.67-44.18), while rapid growth was a significant negative predictor (OR = 0.08, 95% CI = 0.003-0.80).

CONCLUSION

Ultrasound presents a sensitive and reliable method for the evaluation of most pediatric calvarial lesions, especially dermoid cysts, and warrants being part of standard workup. With appropriate patient selection, US obviates the need for additional imaging in pediatric patients.

Pediatric Cranial Vault Pathology

A wide variety of diagnoses can be approached with a common framework for diagnosis, extirpation, and reconstruction of pediatric cranial vault pathologies. Durability of reconstruction is critical for the range of pediatric patients from infancy to adolescence. Rigid reconstruction, preferably with autologous tissue when possible, promotes brain protection and satisfactory aesthetic outcome. Careful planning can allow for immediate definitive reconstruction of defects without need for further surgical intervention.

A solitary scalp mass as the presenting feature of clear cell sarcoma of the kidney in a pediatric patient

Clear cell sarcoma of the kidney is a rare renal malignancy, accounting for 2%-4% of all pediatric renal tumors. In this case report, we describe a 9-year-old boy with an asymptomatic, solitary mass on the scalp, ultimately found to be metastatic clear cell sarcoma of the kidney. This report reviews indications for imaging scalp masses to facilitate making an accurate diagnosis and treatment planning.