Case report:
An 18-month-old girl presented with a non-tender slow-growing skull
lesion in the right parietal region. The lesion was round, and bony
textured on touch(figure1a). The neurological examination was normal.
There was no medical complaint about the lesion other than a cosmetic
problem. The patient had been born by standard vaginal delivery (NVD) to
a nulliparous mother. Based on the mother’s report, the baby suffered
bilateral parietal soft masses just after birth. Although the left-sided
lesion had vanished over time, the other side bulging grew for 18
months.
On the pre-operative examination, it was approximately 7*7*5 cm. The
routine lab test was normal without any coagulopathy. Brain computed
tomography scan (CT-scan) with a bone view showed a hypo-dense expanded
mass between the outer and inner tables of the skull in the parietal
region (Figure 2a) without any enhancement after contrast administration
(Figure2b). History and CT scan were characteristics of OCH, so we
decided against performing an MRI. Under general anesthesia, the skin
was incised semi-circularly around the lesion in the supine position by
turning the head 60 degrees to the left. The pericranium was dissected
from the skin flap intending to use for final cranial reconstruction at
the end of surgery. We performed a craniectomy after placing a burr hole
over the ossified overlying layer on top of the lesion and blunt
dissection over the pseudo-membrane. (Figure 1b, c). Subsequently, the
organized hematoma was dissected circumferentially from the cranial bone
(Figure 1d). After en-block hematoma removal, the uneven lateral borders
of the skull were smoothened using a high-speed drill to maintain the
proper shape of the skull (Figure 1e). Finally, we reformed the surgical
site utilizing a layer of bone chips (harvested from the outer layer of
the hematoma) and an overlying pericranium for better future cranial
bone shaping and remodeling (Figure 1f). The postoperative course was
uneventful. Figures 2c and 2d show the normal contour of the skull just
post-operation. Histopathologic examination confirmed an organized
hematoma with hemosiderin deposition and calcification in line with OCH
(Figure 3).