CASE REPORT Giant cell reparative granuloma of the pediatric cranium: case report and review of the literature Adam Conley & Brian H. Cho & Gary W. Tye & John Reavey-Cantwell & Daniel Coelho & Christine E. Fuller & Jennifer L. Rhodes Received: 9 June 2013 /Accepted: 29 July 2013 /Published online: 13 August 2013 # Springer-Verlag Berlin Heidelberg 2013 Abstract Purpose Giant cell reparative granulomas are rare bone tu- mors. Although benign, these tumors are locally destructive and can be highly vascular. They seldom occur in the cranial vault. We describe a multidisciplinary approach to a case of giant cell reparative granuloma of the cranium in a 3-year-old patient. Case report A 3-year-old girl female referred to the pediatric neurosurgery department for evaluation of a retro-auricular mass. She had a history of recurrent otitis media with two subsequent courses of antibiotics without resolution. CT im- aging revealed an expansive lesion located in the right mastoid region. Open surgical biopsy revealed a hemorrhagic tumor consistent with a giant cell reparative granuloma. Angiogra- phy identified a hypervascular tumor blush that was supplied by the occipital artery. Preoperative transcatheter embolization was performed followed by a multidisciplinary surgical resec- tion and reconstruction. Blood loss was minimal, and the patient recovered well after surgery. Conclusion Preoperative endovascular embolization and a mul- tidisciplinary intraoperative approach with primary resection and cranial vault reconstruction is an effective approach to hypervascular giant cell reparative granulomas. Keywords Giant cell reparative granuloma . Bone neoplasm . Skull . Embolization . Multidisciplinary Introduction The giant cell reparative granuloma (GCRG) is a rare non- neoplastic lesion most commonly associated with mandibular and maxillary regions [3, 9]. To date, few cases of giant cell reparative granulomas have been reported in the cranial vault. This lesion typically occurs after the second decade of life. Previous studies suggest predominance within the female population; however, recent reports of GCRG of the skull show no evidence of gender predilection [3, 15, 21]. Comput- ed tomography (CT) findings of GCRG are often nonspecific, making it difficult to distinguish GCRGs from other osteolytic bone lesion tumors. Brown tumors of hyperparathyroidism, true giant cell tumors, and aneurysmal bone cysts must be considered in the differential diagnosis [8, 12]. The underlying etiology of GCRG has been previously described as a prolif- erative response to trauma. This theory is controversial, how- ever, considering that not all patients with GCRG have a clear history of trauma [21]. We describe a rare case GCRG that developed in the mastoid region of a 3-year-old girl. At the time of presentation, extra and intracranial expansion was sig- nificant. Hypervascularity was identified on preoperative imaging as well as on open biopsy, which prompted preoper- ative endovascular embolization. We also describe the ben- efits of a multidisciplinary operative approach taken to not only minimize intraoperative risk but also to provide better postoperative outcome. A. Conley : B. H. Cho : G. W. Tye : J. Reavey-Cantwell Departments of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA D. Coelho Departments of Otolaryngology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA C. E. Fuller Departments of Pathology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA J. L. Rhodes (*) Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA e-mail: jlrhodes@vcu.edu Childs Nerv Syst (2014) 30:521–526 DOI 10.1007/s00381-013-2254-x