A 21-year-old male was admitted to the Neurosurgery Department because of nodules in the left parietal region that have increased in volume in the last 7 months.
Relevant personal history included mild ataxia and surgical intervention for this condition in childhood (craniectomy + silicon bands + bone fixation with hemoclips).
Spontaneous intraparenchymal cerebral hematoma was treated conservatively.
There are no known trauma episodes.
Physical examination revealed a painless, non-pulsatile, surface-covered, elastic tumor with a normal scalp size of 5x3x3 cm in the left parietal region.
Neurological examination was normal.
1.
Laboratory findings were: hemoglobin, 16g/dl; hematocrit, 50%; leukocytes, 6710, with a normal differential count; platelets, 211000; prothrombin activity, 97%; APTT: 59sec.
Factor VIII: 19%.
Plain radiography and skull CT showed an osteolytic lesion of sclerotic margins at the left parietal level with erosion of the external and internal table and expansion of the diploe.
MRI revealed a well-defined parietal nodule on the same side, with different signal areas inside, with hemoglobin at different stages of evolution: high signal density for methaemoglobin and low signal density for hemoglobin.
1.
A CT scan of the chest, abdomen and pelvis, as well as bone scan, ruled out bone tumor or metastasis.
The patient received 50U/kg/d Factor VIII prior to surgery, which increased her factor VIII level to 89% of normal.
A continuous intravenous infusion of 5U/kg/h of Factor VIII was administered throughout the operation.
1.
Surgical intervention
Under local anesthesia, a scalp incision was made over the tumor and a subperistal dissection was performed in different stages. An elevation and erosion of the external table was also observed, containing the diploe surrounding fibrous tissue.
The internal table was thinned, with irregular ballooning and bone defect.
Hematoma, granular tissue and foreign body (silicone) were removed, as well as the thinned and elevated external table, until reaching thick bone and normal appearance by means of bone curettage.
Histological examination confirmed the presence of old hematoma and granulation tissue.
After surgery, Factor VIII was maintained in 80% of normal activity until suture material was removed.
