Lesions of the Skull and Spine in Children

Gerald A. Grant, MD
Duke Children’s Hospital

General Principles

Clinical Presentation

Congenital Scalp and Skull Defects

Benign Lesions of Skull

Table 1: Benign Tumors of the Skull

Osteoma
RADIOLOGICAL HALLMARKS: Well demarcated, homogenous, arises from inner or outer table, hot on bone scan
TREATMENT RECOMMENDATIONS Resection if symptomatic despite aspirin
Epidermoid
RADIOLOGICAL HALLMARKS: Well defined dense sclerotic margins, hypodense on CT, low intensity on T1W and high signal on T2W MRI
TREATMENT RECOMMENDATIONS resection vs. observation (Is it growing, symptomatic, or a cosmetic concern?), bone margins curetted
Eosinophilic Granuloma
RADIOLOGICAL HALLMARKS: Punched out, non-sclerotic lytic lesion with sharp margins, may have large associated epidural or extracranial soft tissue components
TREATMENT RECOMMENDATIONS resection of unifocal lesions vs. observation if lesion decreasing in size (spontaneous resolution can occur) cranioplasty depending on age and size of defect
Hemangioma
RADIOLOGICAL HALLMARKS: Circular lucency with honeycomb or sunburst (radial trabeculations) pattern
TREATMENT RECOMMENDATIONS resection vs. observation; en bloc excision or curettage

Malignant Skull Tumors (overall incidence 0%-7.7%) (13)

Tumors of the Spine

Malignant Bone Tumors of the Pediatric Spine

References

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