Johnson Keyne K, Dannenbaum Mark J, Bhattacharjee Meenakshi B, Illner Anna, Dauser Robert C, Whitehead William E, Jea Andrew, Luerssen Thomas G
Department of Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.
J Neurosurg Pediatr. 2008 Nov;2(5):370-4. doi: 10.3171/PED.2008.2.11.370.
Primary skull lesions, albeit rare in the pediatric population, have been well described and classified. These lesions are usually benign and commonly present as a painless mass. The most common lesions are epidermoid, dermoid, and Langerhans cell histiocytosis. Cranial fasciitis, encountered less frequently, is usually not considered in this differential diagnosis. Given such few cases reported, it is commonly misdiagnosed preoperatively. The authors retrospectively reviewed data obtained in 4 patients with cranial fasciitis in whom the diagnosis was based on histopathological findings. In 2 patients the onset of the lesion was spontaneous. One patient had a lesion 4 months following a vacuum extraction and subsequent cephalohematoma formation. One patient developed a lesion following a previous craniectomy. Presentation, imaging studies, and histopathological findings were all reviewed and analyzed. All patients presented with a firm nontender mass. Radiological features included a lytic bone lesion with a mildly sclerotic margin, T1 isodensity, T2 heterogeneous hyperdensity, and heterogeneous enhancement. The enhancing portion was not bright on T2-weighted MR images, likely representing the fibrous component; the nonenhancing portion was bright on T2-weighted images, likely representing the myxoid matrix. Histopathological examination revealed proliferating fibroblasts in a myxoid matrix. Cranial fasciitis is a benign, painless but rapidly growing lesion of the skull mainly limited to the pediatric population. It is histologically similar to nodular fasciitis, a fibroblastic proliferation of varying size. These lesions are often related to trauma but can also be insidious or can develop at a prior craniectomy site. The appropriate clinical picture and distinguishing radiographic features may help to differentiate cranial fasciitis from other lesions of the skull allowing for earlier intervention.
原发性颅骨病变在儿科人群中虽较为罕见，但已有充分的描述和分类。这些病变通常为良性，常见表现为无痛性肿块。最常见的病变是表皮样囊肿、皮样囊肿和朗格汉斯细胞组织细胞增生症。颅骨筋膜炎较少见，在这种鉴别诊断中通常不被考虑。鉴于报道的病例很少，术前常被误诊。作者回顾性分析了4例经组织病理学确诊为颅骨筋膜炎患者的资料。2例患者病变为自发出现。1例患者在真空吸引及随后形成头颅血肿4个月后出现病变。1例患者在先前颅骨切除术后出现病变。对临床表现、影像学检查及组织病理学结果进行了回顾和分析。所有患者均表现为质地硬、无压痛的肿块。影像学特征包括溶骨性骨病变，边缘轻度硬化，T1等密度，T2不均匀高密度，以及不均匀强化。在T2加权磁共振图像上，强化部分不亮，可能代表纤维成分；非强化部分在T2加权图像上亮，可能代表黏液样基质。组织病理学检查显示黏液样基质中有增生的成纤维细胞。颅骨筋膜炎是一种良性、无痛但生长迅速的颅骨病变，主要见于儿科人群。其组织学表现与结节性筋膜炎相似，为大小不一的成纤维细胞增生。这些病变常与创伤有关，但也可能隐匿发生或在先前颅骨切除部位出现。恰当的临床表现和独特的影像学特征有助于将颅骨筋膜炎与其他颅骨病变相鉴别，从而实现早期干预。
