Nonoperative management of solitary eosinophilic granulomas of the calvaria

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Observation is a safe and reasonable approach in the management of solitary calvarial EG and may prevent unnecessary surgical interventions.</jats:p></jats:sec>

Disappearing lytic lesion of skull

“…[ 1 2 ] There are studies confirming this type of management and our case also establishes the fact that solitary calvarial eosinophilic granuloma can be managed with observation alone also. [ 1 2 ]…”

“…Localized Langerhans cell histiocytosis, also known as eosinophilic granuloma, is a benign tumor-like condition characterized by clonal proliferation of Langerhans type histiocytes. [ 1 ] The treatment recommended for solitary calvarial eosinophilic granuloma is surgical resection by curettage, craniectomy or craniotomy. [ 1 2 ] Observation alone can be considered in the management of children with solitary calvarial mass which helps in delaying surgical intervention and allow time for spontaneous resolution.…”

“…[ 1 ] The treatment recommended for solitary calvarial eosinophilic granuloma is surgical resection by curettage, craniectomy or craniotomy. [ 1 2 ] Observation alone can be considered in the management of children with solitary calvarial mass which helps in delaying surgical intervention and allow time for spontaneous resolution. [ 1 2 ] There are studies confirming this type of management and our case also establishes the fact that solitary calvarial eosinophilic granuloma can be managed with observation alone also.…”

Adult onset asynchronous multifocal eosinophilic granuloma of bone: an 11-year follow-up

“…The treatment of adult onset EG is not well established, given the rare observation of this condition and several medical or surgical therapeutic approaches have been proposed according to patient age and disease locations ( 13 ). In the literature, this wide variety of proposed treatments includes intralesional methylprednisolone injection with clinical benefit and imaging resolution of the lesions ( 14 ), systemic and local corticosteroid therapy ( 15 ), chemotherapy ( 1 ), radiation therapy ( 16 ), surgery ( 17 ), and surgery in association with chemotherapy with vinblastine ( 18 ).…”

Eosinophilic granuloma/Langerhans cell histiocytosis: Pediatric neurosurgery update

“…As mentioned above, the proliferation of a myeloid-derived precursor dendritic cell with the characteristics of a LC is what characterizes LCH. [ 11 19 ] One theory on the pathophysiology of LCH is based on recently published data that LCH cells express CD40 at high levels, leading to the overactivation of CD40L + T-lymphocytes. The subsequent release of cytokines leads to further recruitment of LC progenitor cells, as well as to the local destruction of bone, fibrosis, and necrosis.…”