Risk of Intracranial Extension of Craniofacial Dermoid Cysts

Plast Reconstr Surg. 2020 Apr;145(4):779e-787e. doi: 10.1097/PRS.0000000000006655.


Background: Dermoid cysts are benign lesions lined by keratinizing squamous epithelium that also contain epidermal adnexa (hair follicles, hair shafts, sebaceous glands, and both apocrine and eccrine sweat glands) and mesodermal derivatives (smooth muscle fibers, vascular stroma, nerves, and collagen fibers). Craniofacial dermoid cysts represent approximately 7 percent of all dermoids and have an incidence ranging between 0.03 and 0.14 percent.

Methods: The authors conducted a single-center, consecutive, nonrandomized comparative case series over a 20-year period of all patients treated surgically for craniofacial dermoid at the Royal Children's Hospital in Melbourne, Australia. Six hundred forty-seven patients had craniofacial dermoids and adequate information to be included in the study. The authors also conducted a thorough review of the literature using the MEDLINE and Embase databases.

Results: Six hundred forty-seven patients amounted to 655 lesions in our case series. The age at surgery ranged from 2 months to 18 years, with an average age of 25.65 months. The depth of the lesions was stratified using a classification system, and the risk of intracranial extension was assessed using these data. Midline nasal lesions are established as high risk by other studies, but frontal, temporal, and occipital lesions were found to be as risky if not more risky for intracranial extension.

Conclusions: Several classification systems for craniofacial dermoid cysts have used both broader anatomical locations and physical characteristics to group these lesions and identify those warranting preoperative imaging. The authors propose a system using more specific classification of anatomical location to assist in the prompt identification of high-risk lesions and facilitate sound preoperative planning.

Clinical question/level of evidence: Therapeutic, V.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adolescent
  • Australia
  • Brain / diagnostic imaging*
  • Brain / pathology
  • Child
  • Child, Preschool
  • Dermoid Cyst / classification
  • Dermoid Cyst / diagnostic imaging
  • Dermoid Cyst / pathology*
  • Dermoid Cyst / surgery
  • Face
  • Facial Neoplasms / classification
  • Facial Neoplasms / diagnostic imaging
  • Facial Neoplasms / pathology*
  • Facial Neoplasms / surgery
  • Female
  • Humans
  • Infant
  • Magnetic Resonance Imaging
  • Male
  • Neoplasm Invasiveness / diagnostic imaging
  • Neoplasm Invasiveness / pathology
  • Patient Care Planning / standards
  • Practice Guidelines as Topic
  • Preoperative Care / methods
  • Preoperative Care / standards
  • Risk Assessment
  • Skin Neoplasms / classification
  • Skin Neoplasms / diagnostic imaging
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / surgery
  • Skull / diagnostic imaging*
  • Skull / pathology
  • Tomography, X-Ray Computed
  • Ultrasonography