Cranial Fasciitis Presenting with Intracranial Mass: A Case Report

Abstract

We describe a very rare case of cranial fasciitis presenting with intracranial mass in a 3-year-old girl. There was no palpable scalp mass. CT scan and MRI demonstrated an epidural mass adherent to the dura with destruction of the inner table of the skull. The tumor was extirpated completely and the resected specimens were diagnosed as cranial fasciitis. When neurosurgeons, pediatricians and radiologists encounter an epidural tumor in a pediatric patient, cranial fasciitis should be kept in mind.

Parasagittal cranial fasciitis following infratemporal fossa rhabdomyosarcoma

“…Cranial fasciitis is a rare, non‐neoplastic benign mesenchymal lesion that occurs almost exclusively in young children. It has a mean age of occurrence of about 2–3 years, and a male‐to‐female ratio of 2:1, with a predilection for females to be affected at a later age . Typically, cranial fasciitis presents as a rapidly growing, infiltrative tumor that appears to behave aggressively, and as such remains elusive to diagnose without appropriate histology …”

“…It has been proposed that the galea capitals and periosteum give rise to those lesions outside the vault while intracranial examples probably originate from the dural layers . Additionally, it has been postulated that the fibromembranous cover of the sutures has the ability to migrate through open sutures and into the epidural space, which then becomes a potential site of origin for cases of intracranial cranial fasciitis . Regardless, it is generally accepted that any fibrous structure may be the site of origin.…”

“…Typical cranial fasciitis appearance is that of a scalp or calvarial mass eroding the underlying cranium and only occasionally extending to attach to the underlying dura. Purely intracranial examples are the exception with only a handful of cases reported thus far . Only one of these cited prior history of malignancy .…”

Cranial fasciitis in an infant

“…13 The exact origin is not clear, but most authors believe that the lesion arises from the deep fascia, periosteum or the fibromembranous layer covering sutures and fontanelles, and often erodes only the outer layer of the skull, typically invading the overlying scalp. 7 Invasion of both layers of the skull with dural invasion and compression of the brain has been reported. 14 A large epidural mass and exclusive intracranial extension with mass effect have also been reported, and even lesions causing significant compression of the superior sagittal sinus and underlying cortex have been described.…”

“…6 To the best of our knowledge, 51 cases have been reported in the literature. 7,8 We hereby add another case of cranial fasciitis in a 7-month-old female with the clinical course, histological appearances and the radiological findings.…”