<%server.execute "isdev.asp"%> Scalloping characteristics in anterior fontanelle dermoid cyst Agrawal A, Goel S, Trehan SS, Mendiratta P, Dureja N - J Pediatr Neurosci
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Year : 2011  |  Volume : 6  |  Issue : 1  |  Page : 92-93

Scalloping characteristics in anterior fontanelle dermoid cyst

1 Department of Neurosurgery, MM Institute of Medical Sciences and Research, Mullana (Ambala), India
2 Department of Surgery, MM Institute of Medical Sciences and Research, Mullana (Ambala), India

Date of Web Publication2-Sep-2011

Correspondence Address:
Amit Agrawal
MM Institute of Medical Sciences and Research, Maharishi Markandeshwar University, Mullana, Ambala - 133 203, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1817-1745.84424

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How to cite this article:
Agrawal A, Goel S, Trehan SS, Mendiratta P, Dureja N. Scalloping characteristics in anterior fontanelle dermoid cyst. J Pediatr Neurosci 2011;6:92-3

How to cite this URL:
Agrawal A, Goel S, Trehan SS, Mendiratta P, Dureja N. Scalloping characteristics in anterior fontanelle dermoid cyst. J Pediatr Neurosci [serial online] 2011 [cited 2023 Dec 1];6:92-3. Available from: https://www.pediatricneurosciences.com/text.asp?2011/6/1/92/84424

Dear sir,

The congenital inclusion dermoid cyst (CIDC) of the anterior fontanelle is a rare but benign and curative lesion, accounting for 0.1-0.2% of all skull tumors. [1],[2] A 3-month-old male infant presented with a gradually increasing swelling located in the midline over the vertex of the head since birth. There were no other associated abnormalities and the child had normal growth and developmental milestones. Clinical examination revealed a soft, cystic, non-compressible 3 × 2.5 × 2.5 cm swelling over anterior fontanelle, covered by normal skin. The lesion was non-pulsatile, not adhering to underlying tissue without any bruit, and transillumination test was positive. Computed tomography (CT) demonstrated an extracranial homogenous hypodense swelling in the midline, overlying and covering anterior fontanelle [Figure 1]. However, apparently there was no intracranial communication. Surgery was done under general anesthesia and the cyst was completely dissected out between the galea aponeurotica and pericranium. There was no tissue connection to the overlying skin or intracranial extension. Any congenital midline lesion of the scalp should inevitably arouse in the clinician's mind the possible existence of some form of intracranial extension. [1],[3] The CIDC is a cystic, soft, and mobile mass, covered by normal skin, without any pain and discomfort or any communication between the cyst and the intracranial cavity. [1],[4],[5] The CDIC of the scalp needs to be differentiated from other cystic lesions of the scalp including encephalocele, meningocele, sebaceous cyst, lipoma, cephalhematoma, lymphangioma or hemangioma, and sinus pericranii. [6],[7],[8] Gross examination will give a clue, but may occasionally not differentiate encephalocele from dermoid cyst, [9] and a detailed imaging is required before neurosurgical intervention. [3] Although skull X-ray can reveal changes that include flattening or depression of the skull underneath the lesion with sclerotic margins, [10],[11] CT scan and magnetic resonance imaging are the best diagnostic exams to confirm the position of the lesion. [11],[12] Sometimes extracranial cystic lesions with clear contents can have all the features of encephalocele on clinical examination, but a careful evaluation of neuroimaging can help us suspect the diagnosis in such cases. [8] On neuroimaging if the lesion is coming out from inside the cranium - it produces scalloping on the inner table of the cranium with their characteristic imaging appearance. [13] However, if the lesion is extracranial (as in the present case), it will characteristically produce the scalloping over outer table of the cranium. [8],[10],[11]
Figure 1: Plain CT scan of the brain with bone window showing hypodense, well-defined extracranial swelling over the anterior fontanelle [please note (d) the thin hyperdense outline of the cyst wall (thick arrow) and pattern of scalloping on the outer table (thin arrows)]

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   References Top

1.Adeloye A, Odeku EL. Congenital subgaleal cysts over the anterior fontanelle in Nigerians. Arch Dis Child 1971;46:95-8.  Back to cited text no. 1
2.Castro RA, Ribeiro Filho Ade S, Silva VV, Jr. Dermoid cyst of the anterior fontanelle in adults: Case report. Arq Neuropsiquiatr 2007;65:170-2.  Back to cited text no. 2
3.Bodkin PA, Bhangoo R, Walsh AR, Sgouros S. Beware of the midline scalp lump. J R Soc Med 2004;97:239-41.  Back to cited text no. 3
4.Glasauer FE, Levy LF, Auchterlonie WC. Congenital inclusion dermoid cyst of the anterior fontanel. J Neurosurg 1978;48:274-8.  Back to cited text no. 4
5.Hayath S, Seetharam W, Kumari G, Dinakar I, Nightingale F. Congenital dermoid cyst over the anterior fontanelle. Br J Clin Pract 1989;43:119-20.  Back to cited text no. 5
6.de Aquino HB, de Miranda CC, de Britto Filho CA, Carelli EF, Borges G. Congenital dermoid inclusion cyst over the anterior fontanel: Report of three cases. Arq Neuropsiquiatr 2003;61:448-52.  Back to cited text no. 6
7.Fermin S, Fernandez-Guerra RA, Lopez-Camacho O, Alvarez R. Congenital dermoid cyst of the anterior fontanel in mestizo-mulatto children. Childs Nerv Syst 2001;17:353-5.  Back to cited text no. 7
8.Agrawal A, Pratap A, Sinha AK, Agrawal B, Thapa A, Bajracharya T. Epidermoid cyst of anterior fontanelle with clear contents. Surg Neurol 2007;68:313-5.  Back to cited text no. 8
9.Gellis SS, Feingold M, Adeloye A. Congenital subgaleal cyst over the anterior fontanel. Am J Dis Child 1975;129:843-4.  Back to cited text no. 9
10.Ogle RF, Jauniaux E. Fetal scalp cysts--dilemmas in diagnosis. Prenat Diagn 1999;19:1157-9.  Back to cited text no. 10
11.Aslan O, Ozveren F, Kotil K, Ozdemir B, Kuscuoglu U, Bilge T. Congenital dermoid cyst of the anterior fontanelle in Turkish children--four case reports. Neurol Med Chir (Tokyo) 2004;44:150-2.  Back to cited text no. 11
12.Stokes RB, Saunders CJ, Thaller SR. Bregmatic epidermoid inclusion cyst eroding both calvarial tables. J Craniofac Surg 1996;7:148-50.  Back to cited text no. 12
13.Moore KR, Fischbein NJ, Harnsberger HR, Shelton C, Glastonbury CM, White DK, et al. Petrous apex cephaloceles. AJNR Am J Neuroradiol 2001;22:1867-71.  Back to cited text no. 13


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