title: Postoperative cranial fasciitis. Report of two cases and review of the literature.
abstract: The authors report two cases of cranial fasciitis occurring at prior craniotomy sites. They review the presentation and pathological features associated with cranial fasciitis and describe two unusual cases and their treatment. The first case is that of a 16-year-old girl who underwent suboccipital craniectomy for resection of medulloblastoma and 14 months later was found to have a 4-cm nontender mass at the incision site, with evidence of skull erosion on neuroimaging. Resection of the mass revealed cranial fasciitis. The patient later developed two more lesions in the cranial region, as well as lesions on the chest wall and abdomen consistent with nodular fasciitis; all of the lesions were resected. The second case is that of a 61-year-old man who underwent suboccipital craniectomy for hypertensive hemorrhage and 2 years later was found to have an enlarging mass at the incision site, causing compression of the cerebellum. The mass was resected and found to be consistent with cranial fasciitis. Cranial fasciitis is a rare, benign lesion of the cranial region. It is histologically identical to nodular fasciitis, a self-limiting fibroblastic process of the superficial and deep fascia. Although most cases of cranial fasciitis are reported to occur spontaneously in the very young, the two cases reported here involved older patients and lesions that developed at prior craniotomy sites in a delayed fashion, a phenomenon not previously reported. Interestingly, one patient exhibited lesions in other areas as well.
authors.affiliation: Department of Neurological Surgery, University of Florida, Gainesville, Florida 32610, USA. equine4@hotmail.com
authors.forename: Lori E
authors.initials: LE
authors.lastname: Summers
authors.forename: Luisa
authors.initials: L
authors.lastname: Florez
authors.forename: Z John M
authors.initials: ZJ
authors.lastname: Berberian
authors.forename: Meena
authors.initials: M
authors.lastname: Bhattacharjee
authors.forename: John W
authors.initials: JW
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D020201:Brain Hemorrhage, Traumatic / Q000601:surgery; D002528:Cerebellar Neoplasms / Q000601:surgery; D003399:Craniotomy; D005208:Fasciitis / Q000209:etiology / Q000473:pathology* / Q000601:surgery*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011183:Postoperative Complications / Q000473:pathology*; D014057:Tomography, X-Ray Computed