Solitary eosinophilic granuloma of the pediatric skull and spine : the role of surgery

Nine pediatric cases of solitary eosinophilic granuloma (EG) are reported. Six children harbored cranial lesions and three had spinal involvement. Plain radiographs and computed tomography scan were not always sufficient for diagnosis. Isotopic bone scan was useful to rule out multiple lesions. The authors' opinion is that surgical excision is the treatment of choice for cranial lesions, leaving radiotherapy for possible relapse. Management of EG of the spine should start with needle biopsy, followed by radiation therapy, surgery being indicated in selected patients with immediate risk of neural compression. Mean follow-up time was 4.4 years (longer than several reported series). At the time of revision all children were asymptomatic, and only one case presented a local recurrence that was managed by radiotherapy.