Ultrasound as a standalone tool for the management of pediatric calvarial dermoid cysts.

Purpose: Calvarial dermoid and epidermoid cysts are benign lesions common in pediatric neurosurgery. Diagnosis is primarily clinical, with frequent but inconsistent use of imaging. Dermoids have been shown to possess distinct sonographic features, but ultrasound (US) remains underutilized in their management. The purpose of this study is to investigate the independent reliability of US in managing pediatric calvarial dermoids and distinguishing them from other calvarial lesions.

Methods: A retrospective review of consecutive patients ≤ 21 years of age with surgically resected calvarial masses between 2017-2024 was performed. Demographic, clinical, and imaging data were analyzed. Pearson chi-squared tests were used for comparison of categorical variables and a binomial linear model was generated controlling for age, lesion tenderness, growth, and suture location.

Results: Fifty-nine patients with 61 lesions (31 in females; median age 13 months) were included. Dermoids were more common in younger patients (median age 12 months), along suture lines, and were less likely to present with tenderness (p < 0.001) or rapid growth (p = 0.003). Ultrasound was used in 83% of cases and was the sole imaging modality in 33%. On multivariate analysis, suture location was a significant positive predictor of a dermoid diagnosis (OR = 8.08, 95% CI = 1.67-44.18), while rapid growth was a significant negative predictor (OR = 0.08, 95% CI = 0.003-0.80).

Conclusion: Ultrasound presents a sensitive and reliable method for the evaluation of most pediatric calvarial lesions, especially dermoid cysts, and warrants being part of standard workup. With appropriate patient selection, US obviates the need for additional imaging in pediatric patients.