Radiological and Surgical Findings of Patients with Intradiploic Mass Lesion: Case Series and Systematic Review.

Abstract

Background and objectives: In this study, our goal is to examine the radiological findings and clinical outcomes of nine patients with intradiploic masses, who were treated at our clinic, along with a comprehensive review of the existing literature.

Methods: The study includes a total of nine adult patients, who were under follow-up and treatment for intradiploic masses from 2015 to 2022. Exclusions from the study criteria comprised patients in the pediatric age group, those with a documented history of cancer, prior cranial surgery, active central nervous system infection, and acute head trauma resulting in cranial damage.

Results: Our study comprised a total of nine patients, with six females and three males, with a median age of 36 years (range: 18-76). Epidermoid cysts were identified in two patients, whereas others presented with cavernous hemangioma, arachnoid/leptomeningeal cyst, intradiploic lipoma, dermoid cyst, arachnoid cyst, fibrous dysplasia, and eosinophilic granuloma. Among the cohort, eight patients presented with headaches. The patient with cavernous hemangioma underwent total resection and mini-plate reconstruction. Similarly, total resection was performed in cases of leptomeningeal cyst (n = 1) and intradiploic lipoma (n = 1). In a single patient, fibrous dysplasia was diagnosed through open biopsy. For the patient with eosinophilic granuloma, total mass excision and chemotherapy were undertaken. Notably, four patients (44.4%), including those with epidermoid cysts (n = 2), dermoid cyst (n = 1), and arachnoid cyst (n = 1), were managed conservatively without surgical intervention.

Conclusions: The use of computed tomography and magnetic resonance imaging in intradiploic lesions seems sufficient to differentiate the mass. However, it may be difficult to reach a definitive diagnosis in some patients without surgery. Therefore, based on the experience of clinical management, it is important to evaluate in detail the various radiological and clinical findings for further therapeutic decision making.