Pediatric Cranial Fasciitis: Discussion of Cases and Systematic Review of the Literature

A Novel Therapeutic Approach for Cranial Fasciitis Utilizing Frameless Stereotaxy

“…Although they cannot recommended guidelines for margins or best treatment, they conclude based on the review of literature that limited boney resection increase the risk of recurrence and more aggressive treatment may reduce the recurrence rate of cranial fasciitis. 2 There have been several reports of dural involvement by cranial fasciitis in the literature; however, it is unclear based on prior systematic reviews of all cases reported to date the incidence rate of muscle involvement (such as in the case we present here). 2 Additionally, reconstructive approaches have yet to be thoroughly described in the present literature.…”

“…Out of the cases with boney involvement, 57% were treated with craniectomy and cranioplasty in 57% and curettage or no bony resection in 34% of cases. 2 Reported recurrence rates range from 7.5% (following bony resection) to 15.7% (treated with curettage or no bony resection), 2 although the number of cases is too small to have statistical significance. Although they cannot recommended guidelines for margins or best treatment, they conclude based on the review of literature that limited boney resection increase the risk of recurrence and more aggressive treatment may reduce the recurrence rate of cranial fasciitis.…”

“…1 Since then, there have been about 80 cases reported to-date, demonstrating the rarity of this diagnosis. 2 Cranial fasciitis typically presents before the age of 6 years as a rapidly enlarging, subcutaneous lesion involving the subaponeurotic loose connective tissue, periosteum or fibromembranous layers of the skull, with the size of lesions ranging from 2.5 to 9 cm in diameter. 3 Although rare, erosion of the underlying calvarium and extension into meningeal layers has been reported.…”

“…8 There have been described 4 main etiologic categories for the progression of cranial fasciitis, namely: hereditary, radiation therapy, post-traumatic, and idiopathic, with post-traumatic cases being the most common. 2 In a recent systematic review of cranial fasciitis cases worldwide, it was identified that 14% of all cases were post-traumatic and 12% were associated with radiation therapy or surgical intervention, leading the authors to suggest that these lesions likely develop as a result of a reactive process. 2 Initial clinical presentation is variable, oftentimes without a history of precluding trauma and without evidence of neurologic deficit on physical examination.…”

“…2 In a recent systematic review of cranial fasciitis cases worldwide, it was identified that 14% of all cases were post-traumatic and 12% were associated with radiation therapy or surgical intervention, leading the authors to suggest that these lesions likely develop as a result of a reactive process. 2 Initial clinical presentation is variable, oftentimes without a history of precluding trauma and without evidence of neurologic deficit on physical examination. 9 However, lesions tend to localize predominantly to the subcutaneous tissue or galea aponeurotica and have even been associated with transcranial invasive propensity.…”