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

RADIOLOGICAL HALLMARKS: Well demarcated, homogenous, arises from inner or outer table, hot on bone scan
TREATMENT RECOMMENDATIONS Resection if symptomatic despite aspirin
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
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


  1. Cochtrane LA, Prince M, Clarke K: Langerhans’ cell histiocytosis in the pediatric population: presentation and treatment of head and neck manifestations. J Otolaryngol 32:33-37, 2003.
  2. Daszkiewicz P, Roszkowski M, Grajkowska W: Aneurysmal bone cyst of the skull and vertebrae in child of own material and review of literature. Folia Neuropathol 24:25-30, 2004.
  3. Davidson L, McComb G, Bowen I, Krieger M: Craniospinal Langerhans cell histiocystosis in children: 30 years’ experience at a single institution. J Neurosurg Pediatr 1:187-195, 2008.
  4. Gibson SE, Prayson RA: Primary skull lesions in the pediatric population. Arch Pathol Lab Med 131:761-766, 2007.
  5. Guzel A, Tatli M, Er U, Yilmaz F, Bavbek M: Multifocal Ewing’s sarcoma of the brain, calvarium, leptomeninges, spine, and other bones in a child. J Clin Neurosci 15:813-817, 2008.
  6. Heckl S, Aschoff A, Kunze S. Cavernomas of the skull: review of the literature, 1975-2000. Neurosurg Rev 25:56-62, 2000.
  7. Kaplan SB, Kemp SS, Oh KS: Radiographic manifestations of congenital anomalies of the skull. Radiol Clin North Am 29:195-218, 1991.
  8. Kocaoglu M, Frush D: Pediatric presacral masses. Radiographics 26:833-857, 2006.
  9. Oliveira M, Steinbok P, Wu J, Heran N, Cochrane D: Spontaneous resolution of calvarial eosinophilic granuloma in children. Pediatr Neurosurg 38:247-252, 2003.
  10. Ruge JR, Tomita T, Naidich TP, Hahn YS, McLone DG: Scalp and calvarial masses of infants and children. Neurosurgery 22:1037-1042, 1988.
  11. Sciubba DM, Hsieh P, McLoughlin G, Jallo G: Pediatric tumors involving the spinal column. Neurosurg Clin N Am 19:81-92, 2008.
  12. Segall L, Cohen-Kerem R, Ngan BY, Forte V: Aneurysmal bone cysts of the head and neck in pediatric patients: a case series. Int J Pediatr Otorhinolaryngol 72:977-983, 2008.
  13. Tsai EC, Santorenos S, Rutka J: Tumors of the skull base in children: review of tumor types and management strategies. Neurosurg Focus 12:1-13, 2002.
  14. Yoon SH, Park SH. A study of 77 cases of surgically excised scalp and skull masses in pediatric patients. Childs Nerv Syst 24:459-465, 2008.