Skull Lesions – Lumps and Bumps
“Lumps” and “bumps” on the head of an infant or child are often a source of concern for parents. Many of these lumps and bumps may only involve the scalp or skin. Some may ultimately involve the underlying skull. Other lesions may not be seen or felt but are found on imaging studies which view the skull.
Skull lesions in children may be congenital (present at birth) or acquired (develop after birth). Primary tumors of the skull are rare. Some of the more commonly recognized pediatric skull lesions include:
- Encephalocele (in-ˈsef-ə-lō-ˌsēl) Tissue inside the skull protrudes through a skull defect. This may be a pocket of brain lining filled with cerebrospinal fluid (meningocele) or brain tissue covered by its lining (meningoencephalocele). These are found more often at the back of the skull than at the frontal-nasal region. They may be seen with other congenital abnormalities.
- Dermoid and epidermoid cysts These are benign “inclusion” cysts that develop when some skin elements get trapped below the scalp. They may involve the scalp or skull. They are the most common lump or bump. They can grow rapidly or virtually not at all. They often present as a painless, firm, non-moving lump.
- Cephalohematoma (sef-əl-ˌhē-mə-ˈtō-mə) This is usually recognized after delivery. It is a hemorrhage underneath the tissue covering (periosteum) attached to the skull plates. The blood clot is confined by the suture lines of the baby’s skull. It usually goes away over time. If the swelling is still present after one month, treatment may be considered.
- Caput succedaneum (sək-sə-ˈdā-nē-əm) This hemorrhage occurs during the birth process. Blood and fluid accumulate under a scalp layer called the galea. This fluid collection spans across the suture lines of the baby’s skull. It usually occurs at the crown of the head.
- Osteomyelitis This is an infection of the bone in the skull. It can result from surgery or a scalp wound, or develop from a sinus or ear infection.
- Pott’s puffy tumor This usually develops from a frontal sinus infection or trauma. It is an osteomyelitis of the front of the skull with an abscess between the bone and its covering layer (periosteum).
- Benign (non-cancerous) tumor
- Osteoma This is more common in adults. It presents as a painless, well-defined lump of bone on the skull.
- Lipoma This is a benign tumor of adipose (fat) cells. It presents as a painless lump below the skin.
- Intraosseus hemangioma This is a well-defined, benign vascular lesion within the skull. It may expand the outer surface of the skull.
- Eosinophilic (ē-ə-ˌsi-nə-ˈfi-lik) granuloma This is a benign form of an immune system disorder called Langerhans-cell histiocytosis. It is localized to bone. The skull is a common site. It is usually a single lesion that presents in young children as an area of swelling with pain and tenderness. It may resolve on its own in infancy, but it may require treatment especially if found at a later age. When the immune disorder involves multiple body systems, multiple bone lesions can also be seen.
- Infantile hemangioma This is the most common vascular growth in an infant. It often involves the face and neck. It grows rapidly in the first few weeks of life and then resolves on its own.
- Malignant (cancerous) tumor
- Metastatic lesions Fortunately, this is rare. Neuroblastoma is the childhood cancer most likely to spread to the skull. Other cancers that may involve the skull are Langerhans-cell histiocytosis, leukemia, lymphoma or sarcoma.
A skull lesion may be felt as a lump or bump. It may be found by chance on an imaging study. Several different imaging techniques, biopsy or surgical removal may be needed to make a diagnosis. Imaging tests may include plain skull x-rays , CT scan , MRI scan or ultrasound .
Your provider may or may not order further testing to evaluate a skull lesion based on its location, presentation and associated symptoms.
Congenital and benign lesions are more often identified in newborns and infants. Inflammatory and tumor lesions are more likely in older children.
Once a skull lesion has been identified and evaluated, the pediatric neurosurgeon will help you decide if the lesion needs surgical removal. Surgery may be recommended to determine the diagnosis, prevent further growth, improve appearance or provide relief of pain. Surgery may be simple and done on an outpatient basis. Sometimes it may require a stay in the hospital.
The Goodman Campbell pediatric neurosurgery providers are experts who are specially trained in the care of all types of skull lesions. We know this can be a scary time for a family. We have a team of medical professionals who are available to answer any questions that you might have.
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