Cranial osteomas: Their classification and management - Report on a giant osteoma and review of the literature

BACKGROUND Cranial osteomas are regarded by some as very common; yet their classification, symptomatology, and management have been neglected. METHODS We report on a giant enostotic convexity osteoma and have reviewed the medical literature. RESULTS A new comprehensive classification for cranial osteomas is proposed: (1) intraparenchymal, (2) dural, (3) skull base, and (4) skull vault. The latter is in turn, subdivided into exostotic and enostotic variants. Three symptom producing enostotic convexity osteomas have been reported in the world literature. We also describe a giant enostotic skull vault osteoma and propose an original surgical technique used to successfully resect this unusual tumor. CONCLUSIONS Most cranial osteomas are asymptomatic and need not be resected. Those that are symptomatic should be managed properly. Their excision, if not properly performed, may lead to unforeseen cerebral complications. (C) 1997 by Elsevier Science Inc.