title: Nonoperative management of solitary eosinophilic granulomas of the calvaria.
abstract: OBJECTIVE
  Solitary eosinophilic granuloma (EG) of the calvaria is most commonly treated with surgical excision. The authors hypothesize that many solitary EGs will resolve without intervention, and observation may be a reasonable option. This study was undertaken to investigate that hypothesis.
  
  
  METHODS
  The authors reviewed their institutional records and identified 14 cases of solitary calvarial EG. In 6 cases the patients underwent resection based on family and/or neurosurgeon preferences. A strategy of nonoperative management (purposeful observation) was chosen for the other 8 cases. The authors report the clinical course and imaging results in these 8 cases.
  
  
  RESULTS
  One of the 8 patients underwent surgery 2 months after presentation because of slight enlargement of the lesion and increasing pain. After a median follow-up period of 1 year (range 6-19 months), none of the other patients had required surgery. Five of these 7 patients had pain at presentation. Pain resolved completely in all 5. The remaining 2 remained asymptomatic. Complete resolution of pain was reported in the 5 patients who had pain at presentation. There was complete clinical resolution of the palpable soft-tissue lesion in all 7 cases. Complete radiographic resolution of the lesion was observed in 5 cases and near-complete resolution in the remaining 2.
  
  
  CONCLUSIONS
  Observation is a safe and reasonable approach in the management of solitary calvarial EG and may prevent unnecessary surgical interventions.
authors.affiliation: Division of Hematology Oncology, Miami Children's Hospital Cancer Center and Herbert Wertheim College of Medicine, FL 33155, USA. Guillermo.deangulo@mch.com
authors.forename: Guillermo
authors.initials: G
authors.lastname: De Angulo
authors.forename: Sushmita
authors.initials: S
authors.lastname: Nair
authors.forename: Vivian
authors.initials: V
authors.lastname: Lee
authors.forename: Ziad
authors.initials: Z
authors.lastname: Khatib
authors.forename: John
authors.initials: J
authors.lastname: Ragheb
authors.forename: David I
authors.initials: DI
authors.lastname: Sandberg
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004803:Eosinophilic Granuloma / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012886:Skull / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D057832:Watchful Waiting