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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282XOn-line version ISSN 1678-4227

Arq. Neuro-Psiquiatr. vol.61 no.2B São Paulo June 2003 

Congenital dermoid inclusion cyst over the anterior fontanel: report of three cases


Cisto dermóide de inclusão congênita sobre a fontanela anterior: relato de três casos



Humberto Belem de AquinoI; Carla Ceres Villas de MirandaI; Cyro Alves de Britto FilhoI; Edmur Franco CarelliII; Guilherme BorgesII

INeurosurgery Service of Hospital Municipal Dr. José de Carvalho Florence, São José dos Campos, SP, Brazil
IIDiscipline of Neurosurgery, Department of Neurology, Faculty of Medical Science, State University of Campinas UNICAMP, Campinas SP, Brazil




Congenital dermoid inclusion cyst over the anterior fontanel (CDIC) is an uncommon cystic lesion located over the anterior fontanel. It is a benign and curative lesion and most of the time, can be diagnosed at birth. From 1994 to 2001, three patients were operated with this kind of lesion and after reviewing the literature we found 229 cases and only 6 cases described in Brazil. Our objective in this study is to report three more cases.

Keywords: congenital inclusion, dermoid cyst, epidermoid cyst, anterior fontanel.


Cisto dermóide de inclusão congênita sobre a fontanela anterior (CDIC) é lesão rara localizada na região da fontanela anterior. Trata-se de lesão benigna e curável que, na maioria das vezes, é diagnosticada no nascimento. De 1994 a 2001, três pacientes foram operados com este tipo de lesão e, através dos dados disponíveis na literatura, verificamos somente 229 casos descritos, apenas 6 descritos no Brasil, o que nos motivou a registrar mais três casos.

Palavras-chave: inclusão congênita, cisto dermóide, cisto epidermóide, fontanela anterior.



Many different types of lesions over the children's skull exist and some are commonly diagnosed in daily practice. Congenital dermoid inclusion cyst over the anterior fontanel (CDIC) is a rare and benign lesion located over the anterior fontanel. Many children are examinated with lesions over the skull in our hospital. In a recent review of these children, our attention was drawn to three patients with a cystic rounded mass over the anterior fontanel. These three patients showed no neurological abnormality and the diagnosis of CDIC were confirmed by surgery and histological examination. Our literature search found 229 other cases (Table 1) of CDIC worldwide.




From 1994 to 2001, three patients were operated with a cystic mass over the anterior fontanel, being of different ages and without neurological abnormality at the time. The first patient a three-year-old-white boy. The second patient (Fig 1) a five-month-old-black girl and the third patient (Fig 2) a five-month-old-white boy. All patients were treated with surgery and using the same approach for each of them (Figs 3 to 12 - the second patient shows all the surgical steps, for better illustration). All three patients presented in this paper are similar in all aspects when compared to those in other papers. Two patients were reviewed recently. The first patient (Fig 13 - no photograph prior to surgery) has a learning disability but is not due to the cyst. He was noted to have a small lipoma over the callosal body. The recent photograph shows the cyst has not recurred. The second patient (Fig 14 - recent photograph) does not have any neurological abnormality and the cyst has not recurred. We were unable to contact our third patient but during his last examinations we did not find any problems with him. Photos published with written authorization given by the patient´s parents.

















Congenital dermoid inclusion cyst over the anterior fontanel is reported as an uncommon cystic lesion, located over the anterior fontanel. Adeloye and Odeku (1971)1 were the first to publish a clear and complete description about this lesion, having treated eighteen patients. CDIC is a cystic mass covered by normal skin. It is soft, mobile and it does not cause discomfort, pain or throbbing. There is no communication between the cyst and intracranial cavity. Several cystic sizes have been reported1-4, this depending on the age of patient at the time of diagnosis. Most of the time, the diagnosis can be made at birth, although some authors have reported adult cases4-6. CDIC is a developmental tumor due to inclusion of dermal elements within the neuroaxis between the third and fifth week of the embryogenesis when the ectoderm folds into the neural tube6,7. Based on its pathogenesis, they can be classified as: 1) congenital dermoid cyst of the teratoma type that is derived from the embryogenic epithelium, confined to the ovaries and testis; 2) acquired implantation dermoid cyst formed by cells implanted traumatically into deeper structures; 3) congenital dermoid inclusion cyst resulting from the inclusion of displaced dermal cells along the embryonic fusion line7. Histologically, the cyst wall is lined by squamous epithelium and inside the cyst exists adnexial appendage structures including hair follicles, sebaceous and sweat glands8-13. There are factors that change other lesions over the anterior fontanel, such as epidermoid cyst. The fluid content can be clean or yellow, depending on the size and age of the lesion and exocrine sweat gland content and some authors discovered sodium, potassium, chloride and glucose concentrations within their cases, has been low incidence14,15. A skull X-ray will show the shadow of the swelling in the extracranial space and can reveal changes which include flattening of the outer table underneath the swelling or some depression16,17. In the past, some authors injected air or contrast medium (Pantopaque), others used ventriculography, in order to show interconnection between the cyst and intracranial cavity18. Currently, CT and MRI are considered the best examination methods, to confirm its extracranial position19-21. Encephalocele, meningocele, hemangioma, lipoma, cephalohematoma, sebaceous cyst, pilonidal cyst and sinus pericranii are important parts of the differential diagnosis22-30. There are no reports about neurological abnormality or any recurrence of the lesion. The surgical indication is based on preventing subsequent infection, pathological diagnosis and an aesthetic aspect.

In conclusion this lesion is benign, simple and easy to treat by surgery and free of significant surgical complication. However, we believe there is a greater number of such cases, other than the 229 already reported. Perhaps other cases have not been reported because it is considered to be a simple lesion. In the cases reported in the literature, we did not find any description addressing the long-term outcomes of patients who were treated. Therefore, we are including our cases in order to provide a long-term view of this condition. We predict our results will prove that CDIC is a benign and curative lesion.

Acknowledgments - We thank Lynn Falkner from Salt Lake City (Utah – USA), Carolina Brom from Caçapava (São Paulo) and Andy Shepherd from England, for English support.



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Received 12 April 2002, received in final form 28 January 2003
Accepted 30 January 2003



Dr. Humberto Belem de Aquino - Rua Jaime Spinelli 5 - 12282-436 Caçapava SP – Brasil. E-mail:

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