An 8-year-old girl with no known medical history.
A small left supra-auricular swelling with no other accompanying symptoms was detected, which was assessed by the family physician and interpreted as an epicraneal hematoma, even in the absence of a traumatic history.
Five months later the child complained of local pain and growth of the lesion.
Researched with skull radiography showing a left temporal lesion.
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He was a reference for neurosurgery consultation.
On examination, the patient had normal upper functions, with no focal neurological deficits, fundus of eye without papilledema, although with slight turgidity.
A CT scan showed a heterogeneous density "voidable temporal bone lesion, expansive bone lesion, located approximately 48 mm in diameter.
It causes marked deformation and superior and medial deviation of the anterior portion of the left temporal lobe as well as protrudes into the epicraneal tissues causing deformation and displacement in the anterolateral direction of the temporal muscle".
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The research was completed with Magnetic Resonance Imaging (MRI) that allowed to observe a "left temporal expansive lesion, heterogeneous, with endo- and extra-craneal component.
The lesion captures contrast intensely and homogeneously.
It controls the temporal lobe and exerts a mass effect on the mesencephalon at a distance, causing herniation of the left parahippocampus uncus, as shown in Figure 3.
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Surgical treatment was proposed, consisting of complete resection and subsequent cranioplasty with titanium net.
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During the intervention, a bone swelling was observed macroscopically, with partially eroded external table, of heterogeneous consistency with some cystic areas, very bleeding regions, areas of hard consistency and atherosclerotic plaques.
The temporal muscle was thinned with a conserved dissection plane.
It was possible to perform a complete resection of the seated lesion.
There were no incidents during the surgical-anesthetic procedure.
The samples corresponded to septations fibrotic and partially ossified involving cavities with blood, some reached 1.2 cm in diameter larger.
Histological diagnosis was complex aneurysmal cyst.
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In the postoperative follow-up, MRI performed 7 months after surgery showed no tumor recurrence.
The aesthetic surgical result was very satisfactory.
In the subsequent evaluation (11 months later) the patient was well and without complaints.
