LESIONS OF THE CALVARIA - SURGICAL EXPERIENCE WITH 42 PATIENTS

Background: Lesions of the calvaria (cranial vault), whether benign or malignant, are rare, and the number that require surgical attention i s very limited. During a 13-year period, 42 patients ranging in age fr om 13 to 82 years were treated surgically at our institution for lesio ns involving primarily the calvaria. The patients were found to have 1 6 benign lesions, 21 malignant lesions, and 5 pathologically ill-defin ed lesions. At last follow-up, 23 patients were still alive. Methods: Criteria for choosing surgery as the preferred therapeutic modality in cluded (a) uncertain diagnosis; (b) benign lesions with a high probabi lity of total removal; 3) malignant lesions that represented the only residue of a systemic malignancy that was in remission; or (d) lesions that were rapidly enlarging, were causing significant symptoms, or we re unresponsive to radiation or chemotherapy. Results: Preoperative ne edle biopsy was useful for some patients in establishing a definitive diagnosis and in providing the basis for the most effective treatment strategy. Most lesions were treated with either craniectomy alone (n = 16) or with craniectomy and cranioplasty (n = 26). Six of the 42 pati ents had postoperative complications. There was no operative mortality . Conclusion: This review of a series of patients with calvarial lesio ns provides an outline of the overall diagnostic workup and management of this unique patient population.