title: Open and endoscopic excision of calvarial dermoid and epidermoid cysts: a single center experience on 128 consecutive cases.
abstract: OBJECTIVE
  Dermoid and epidermoid cysts rank among the most common pediatric tumors. We analyzed the outcomes of surgical excision of dermal and epidermal inclusion cysts in a large consecutive series of children.
  
  
  METHODS
  We retrospectively reviewed 128 consecutive children who underwent calvarial inclusion cyst resection between 2000 and 2010 at NYU Langone Medical Center. Demographic information, neurological exam, lesion location, lesion diameter, type of treatment, extent of resection, time of follow-up, and recurrence were collected.
  
  
  RESULTS
  The cohort includes 67 girls (52.3 %) and 61 boys (47.7 %). Age at diagnosis ranged from birth to 6.5 years (mean of 1.2 years) with surgical intervention between 1 month and 20 years of age (1.5 ± 2.1). Of the 128 patients, 107 underwent open resection. Surgical approach was determined by the senior surgeon. Location, postoperative cosmesis, and family preference were the determining factors. Endoscopic resection was favored with supraorbital and glabellar lesions (75 % endoscopic versus 25 % open) using a rigid scope via a single incision. Erosion of the outer table and involvement of the inner table was noted in 20 patients (15 %), 14 of which were reconstructed using a split thickness calvarial graft. These lesions were noted to be significantly larger than lesions where cranioplasty was not used (1.9 ± 2.81 cm versus 1.23 ± 0.98 cm, p = 0.022). Gross total resection was achieved in all cases.
  
  
  CONCLUSIONS
  Complete removal and cure from dermoid and epidermoid inclusion cysts are possible. Complications are few. Endoscopic approaches are useful to improve cosmesis and limit tissue damage for lesions near the orbits.
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, 317 East 34th Street, New York, NY, 10016, USA. John.engler@alumni.med.nyu.edu.
authors.forename: John
authors.identifier: http://orcid.org/0000-0001-8880-1213
authors.initials: J
authors.lastname: Engler
authors.affiliation: Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bassani
authors.affiliation: Department of Neurosurgery, University of Pennsylvannia, Philadelphia, PA, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Ma
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, 317 East 34th Street, New York, NY, 10016, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Tanweer
authors.affiliation: Main Line HealthCare Neurosurgery, Newton Square, PA, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Elliott
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, 317 East 34th Street, New York, NY, 10016, USA.|Division of Pediatric Neurosurgery, New York University Langone Medical Center, 317 East 34th Street, New York, NY, 10016, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Harter
authors.affiliation: Department of Neurosurgery, New York University Langone Medical Center, 317 East 34th Street, New York, NY, 10016, USA.|Division of Pediatric Neurosurgery, New York University Langone Medical Center, 317 East 34th Street, New York, NY, 10016, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Wisoff
mesh_terms: D002648:Child; D002675:Child, Preschool; D003884:Dermoid Cyst / Q000601:surgery*; D004814:Epidermal Cyst / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery*
keywords: Dermal; Endoscope; Epidermal; Inclusion cyst; Resection