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Skull Dermoid

What is a Skull Dermoid in Children?

A skull dermoid, also known as a dermoid cyst of the skull, is a type of congenital (present at birth) benign tumor that can occur in children. Dermoid cysts are composed of tissue that is typically found in the skin and sometimes in deeper layers of tissue, like hair, sweat glands, and sebaceous glands.

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In the case of a skull dermoid, the cyst forms within the bones of the skull or just beneath the skin of the scalp. It occurs due to a developmental abnormality during embryonic growth, where a piece of skin and its associated structures become trapped during the formation of the skull. This trapped tissue continues to grow slowly over time, leading to the formation of a cyst.

What Might Cause a Skull Dermoid in a Child?

​A skull dermoid, also known as a dermoid cyst of the skull, is a type of congenital (present at birth) benign tumor that can occur in children. These cysts typically arise due to developmental anomalies during embryonic growth. While the exact cause of skull dermoids is not always fully understood, there are several factors that might contribute to their development:

  1. Embryonic Development: During embryonic development, certain tissue layers that are supposed to be separate might become trapped or misplaced. A skull dermoid occurs when a piece of ectodermal tissue (which forms the skin and its associated structures) becomes trapped within the developing skull bones.

  2. Failed Fusion: The bones of the skull form from separate plates that gradually fuse together. If this fusion process is disrupted in some way, it might create spaces where dermoid cysts can develop.

  3. Genetic Factors: While the exact genetic factors aren't always clear, there might be genetic predispositions that make some children more susceptible to developing dermoid cysts.

  4. Environmental Factors: It's possible that certain environmental factors during pregnancy could play a role in the development of dermoid cysts. However, specific associations have not been clearly identified.

  5. Spontaneous Development: In some cases, dermoid cysts might develop spontaneously without any identifiable cause.

Abnormal Development during Fetial Growth Causes Skull Dermoid in a Child
What Symptoms Might a Skull Dermoid Cause in Children?

Skull dermoid cysts in children can cause a variety of symptoms depending on their size, location, and the structures they affect. Symptoms can range from mild to severe. Here are some potential symptoms that a skull dermoid cyst might cause in children:

Skull Dermoid Causing Mass on a Child’s Head
Skull Dermoid Causing Vision Problems in a Child

  1. Palpable Lump or Mass: One of the most noticeable symptoms is the presence of a palpable lump or mass on the child's scalp. This lump might be soft to the touch and could vary in size.

  2. Swelling or Bulging: The cyst can lead to swelling or bulging in the affected area of the scalp. This might be more pronounced if the cyst is growing or becoming infected.

  3. Pain or Discomfort: Larger or infected cysts can cause pain or discomfort. The child might experience localized pain at the site of the cyst.

  4. Redness and Warmth: If the cyst becomes infected, it might cause the skin over the cyst to become red, warm to the touch, and tender.

  5. Infection: Infected dermoid cysts can lead to symptoms such as fever, increased pain, and drainage of pus or fluid from the site.

  6. Cosmetic Concerns: Depending on the location of the cyst and its appearance, parents might be concerned about the cosmetic implications as the child grows older.

  7. Pressure on Adjacent Structures: Depending on its location, a skull dermoid could exert pressure on the bones of the skull or on underlying tissues, potentially causing headaches, vision problems, or other neurological symptoms.

  8. Hair Growth from the Lump: Dermoid cysts are known to contain tissues like hair follicles, so it's possible for hair to grow out of the lump. This can be a distinctive feature of these cysts.

What Treatments are Available for Skull Dermoid in Children?

Once your child's arachnoid cyst has been diagnosed and its size and location thoroughly assessed, I (as a pediatric neurosurgeon in New York) will work with you, your child, and other medical professionals at Children's Hospital at Montefiore (CHAM) to formulate a customized treatment strategy tailored to your child’s needs. This customized treatment may utilize any one or a combination of the following interventions:

Surgical Removal: Surgical removal is the primary treatment for skull dermoids. The procedure is usually performed by a pediatric surgeon or a neurosurgeon with expertise in pediatric cases. The surgery aims to completely remove the cyst, including any associated tissues and structures.

  • Incision: An incision is made in the scalp, carefully planned to minimize scarring and to provide access to the cyst.

  • Cyst Removal: The cyst is carefully dissected and removed from the surrounding tissues and bones. In some cases, the cyst might be adhered to surrounding structures, so delicate dissection is required to avoid damage to those structures.

  • Bone Repair: If the cyst has caused any defects in the skull bone, these defects are repaired during the surgery.

  • Closure: After the cyst is removed and any necessary repairs are made, the incision is closed using surgical techniques that minimize scarring.

  • Pathology Examination: The removed cyst and its contents might be sent to a pathology laboratory for further examination to confirm the diagnosis and ensure that the cyst is indeed benign.

Dr. Behbahani operating on a Skull Dermoid
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