The congenital bregmatic dermoid: an African cyst?

Thirty-five children with bregmatic dermoids were operated on at the Red Cross War Memorial Children's Hospital and Groote Schuur Hospital between 1969 and 1990. Most children were under 1 year of age; 20 were males and 15 females. Thirty-one were African or of African descent, two were Indian and two Caucasian, an ethnic distribution which roughly approximates the ethnic ratio of patients attending our hospital. Most were investigated with skull X-rays and CT scan, but MRI was performed where further clarity was needed. Other lesions mimicking bregmatic dermoids included four haemagiomas, two hamartomas, two lipomas and one encephalocoele through the anterior fontanelle. One bregmatic lipoma was associated with a lipoma of the corpus callosum. All bregmatic cysts were removed through a simple elliptical incision and on connection with the central nervous system or its coverings was encountered in any patient. The pathology in all specimens reviewed (75%) revealed skin appendages to be present in the cyst wall. No epidermoids were found in this series. This series is the largest to date and adds another 31 patients of African descent to the accumulated literature which suggests that although universally distributed, the bregmatic dermoid still appears to be more common in Africans or their descendants.