Craniotomy with local autologous bone dust in pediatric single Langerhans cell histiocytosis

The treatment paradigm for surgery in patients with Langerhans cell histiocytosis (LCH) varies depending on the size and location of the tumor. Here, we illustrate an effective treatment modality through craniotomy with local autologous bone dust. An 8-year-old child presented with a 4-month history of a bumpy scalp on the right parietal region every time he combed his hair. Contrast-enhanced computed tomography (CT) of the brain revealed a single right parietal lytic bony defect measuring 2 × 2 × 1 cm, giving a punched-out appearance. The ultrasound of the abdomen, axial skeleton, and vertebral column was normal. A craniotomy and en bloc resection, including a 2 cm surrounding bone margin, were performed. The healthy skull bone edges (outer table) were drilled, and bone dust was used for reconstruction. The bone dust was spread over the dura to completely fill the defect site, followed by tack-up stitches. The healthy periosteum was laid over the defect and sutured. A follow-up brain CT before discharge and at 1 year showed evidence of cranial bone regeneration. Histopathology specimens showed LCH features. Complete excision, including the margin, followed by covering the defect using autologous bone dust, promotes osteoblast activity in pediatric calvarial. The peripheral tack-up stitches of the dura and periosteum contribute to osteogenesis by contact. This strategy is simple, inexpensive, and has good cosmetic results.