Predicting Pathology by Location: Mapping of 180 Pediatric Cranial Inclusion Cysts.

INTRODUCTION

This study investigates the hypothesis that anatomical localization on the cranium dictates the internal composition of pediatric inclusion cysts, statistically mapping how specific scalp positions predispose lesions to distinct contents such as fluid or hair.

METHODS

A retrospective study of 180 pediatric patients who underwent surgical treatment for cranial inclusion cysts was performed. Demographic data, lesion localization, imaging findings, intraoperative characteristics, and histopathological results were analyzed.

RESULTS

Median age at surgery was 13 months (range 2-217 months), with equal sex distribution. Most lesions were laterally located (69%) near fusion zones, with frontal localization predominating (77%). Periorbital lesions represented the most common subtype. Bony involvement was identified in 75% of cases; however, no lesions demonstrated intradural extension. Anterior fontanelle midline lesions demonstrated strong positive associations with fluid content (OR 24.2, p < 0.001) and occipital with hair elements (OR 18.1, p < 0.001).

CONCLUSIONS

Pediatric cranial inclusion cysts demonstrate distinct anatomical and radiological patterns associated with cyst content and histopathological subtype. Midline lesions, particularly anterior fontanelle cysts, are more likely to contain fluid. Occipital cysts are more likely to contain hair elements. Despite frequent bony involvement, intradural extension was not identified in this cohort.