Clinical Characteristics and Surgical Management of Calvarial Tumors: A Single-Center Retrospective Study

Background/Objectives: Calvarial tumors form a heterogeneous group of benign and malignant lesions, and institutional series remain limited, particularly from Türkiye. This study aimed to describe the clinical, radiological, histopathological, and surgical features and histology-specific outcomes of calvarial tumors treated at a single neurosurgical center. Methods: We retrospectively reviewed 42 patients who underwent surgery for histopathologically confirmed tumors and tumor-like lesions of the cranial vault between 2019 and 2024. Clinical, imaging, histopathological, surgical, and follow-up data were analyzed. Results: The cohort comprised 24 men and 18 women (mean age 42.6 ± 15.3 years; range 7–78). A palpable mass was the most common complaint (64%), and the frontal bone was the most common site (38%). Lesions were benign in 25 patients (60%, including 6 with fibrous dysplasia) and malignant in 17 (40%); osteoma and metastasis were the leading diagnoses. Malignant tumors were larger and had a shorter symptom duration than benign lesions. Total resection was achieved in 36 patients (86%). During a mean follow-up of 32 months, recurrence occurred in 8% (95% CI 2–25%) of benign and 35% (95% CI 17–59%) of malignant tumors (p = 0.045); 8 recurrences occurred after total resection. Conclusions: In this surgical series, a short symptom duration, larger lesion size, and destructive CT features were associated with malignancy, although their diagnostic accuracy requires validation in larger cohorts. Recurrence was uncommon in those with benign lesions but occurred in about one-third of those with malignant tumors, which therefore require multidisciplinary management and close surveillance. Because recurrence also occurred after total resection, the extent of resection alone did not ensure local control.