Don't make a mountain out of dermoid cysts of the anterior fontanelle.

Dermoid cysts are ectodermal inclusion lesions which can occur at the bregma, preventing complete closure of the anterior fontanelle. Various management strategies have been suggested for children presenting with such lesions. We describe the experience of managing a series of 13 consecutive patients at the University Hospital of Wales, Cardiff, including pre-operative workup, operative strategy, post operative care and follow up. Referred patients underwent a form of cross-sectional cranial imaging. All patients were given a general anaesthetic and had a small coronial incision over the lesion, large enough only to expose the lesion. Circumferential dissection of the lesion was then performed, taking particular care at the base of the lesion. We found no intra-dural or intra-sinus connection at the base of any lesion. All patients were discharged on the same day of surgery and were seen once in person or via telephone at follow-up prior to discharge. There have been no recurrences of any lesions. We conclude that these patients can be managed safely as day case procedures and discharged after single follow-up. Although a theoretical risk of intra-sinus or intra-dural connection exists, we suspect this is extremely rare.