Post-radiation cranial fasciitis in a pediatric medulloblastoma survivor: A case report and systematic review

Abstract

Introduction and importance: Cranial fasciitis (CF) is a rare, benign fibroproliferative lesion primarily affecting children. Post-radiation CF is particularly uncommon, and has been reported in only seven previous cases. Its presentation often mimics malignancy, with nonspecific preoperative findings complicating the diagnosis, therefore necessitating early intervention.

Case presentation: We report a 12-year-old male with a history of medulloblastoma treated with chemoradiotherapy four years ago, who presented with a progressive right temporo-occipital scalp mass. Imaging showed an extradural mass with calvarial bone erosion. Complete surgical excision was performed, and histopathology confirmed CF. No recurrence was observed at six-month follow-up.

Clinical discussion: Post-radiation CF is an extremely rare complication of radiotherapy. Due to its rapid growth, bony invasion, and occasional intracranial extension, it can be misdiagnosed as a radiation-induced neoplasm. Given the overlap in clinical and radiologic features with malignancies such as meningioma or sarcoma, histopathological confirmation is essential. Unlike neoplasms, CF follows a benign course, and complete surgical excision is often curative.

Conclusion: Post-radiation CF should be considered in children with prior radiotherapy presenting with scalp masses. Early diagnosis and surgical intervention are crucial for avoiding unnecessary treatments and ensuring favorable outcomes.

Keywords: Case report; Child; Cranioplasty; Fasciitis; Radiotherapy; Scalp.

Graphical abstract

Fig. 1

Preoperative imaging (A) T1-weighted MRI sagittal view with contrast enhancement showing a right temporo-occipital mass with heterogeneous signal intensity extending to the skull. (B) T1-weighted MRI coronal view with contrast enhancement demonstrating the extra-axial nature of the lesion with enhancement and adjacent bone involvement. (C) T1-weighted MRI axial view with contrast enhancement clearly delineating the right temporo-occipital mass. (D) CT brain window axial view revealing the soft tissue component of the mass with isodense appearance. (E) CT bone window axial view highlighting the lytic bone lesion with destruction of the right temporo-occipital bone.

Fig. 2

(A) Intraoperative appearance of the mass following craniotomy of the occipital bone, (B) The lesion has been dissected from the dura, with no signs of dural invasion.

Fig. 3

Postoperative computed tomography showing complete mass removal with titanium mesh cranioplasty, (A) bone window and (B) brain window.

Fig. 4

The examination reveals a proliferation of spindle-shaped fibroblasts and myofibroblasts embedded within a collagenous and myxoid stroma (hematoxylin and eosin, x40), (hematoxylin and eosin, x100), and (hematoxylin and eosin, x400).

Fig. 5

PRISMA flow diagram.