Hindawi Publishing Corporation

Case Reports in Neurological Medicine

Volume 2016, Article ID 2096701, 4 pages
http://dx.doi.org/10.1155/2016/2096701

Case Report
A Rare Case Report on Suboccipital Region
Benign Giant Osteoma

Sunil Munakomi and Binod Bhattarai

Department of Neurosurgery, College of Medical Sciences, P.O. Box 23, Chitwan, Nepal

Correspondence should be addressed to Sunil Munakomi; sunilmunakomi@gmail.com

Received 5 December 2015; Accepted 21 February 2016

Academic Editor: Jacqueline A. Pettersen

Copyright © 2016 S. Munakomi and B. Bhattarai. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Herein we report a rare case of a giant suboccipital osteoma in a 55-year-old woman presenting primarily due to cosmetic issue. We
discuss the management algorithm taken in the patient, highlighting excision of a potentially curable bony tumor only after ruling
out its extension to the ear cavity, mastoid ear cells, transverse sinus, and the intracranial compartment.

1. Introduction nerves were intact. The otoscopic examination was normal.

CT scan revealed a hyperostotic spherical lesion measuring
Osteomas in the occipital and mastoid regions are exception- 6 × 5 cm2 within the right suboccipital region highly sugges-
ally rare with only 137 cases reported in the literature [1–3]. tive of a giant osteoma (Figure 2). Because of the large size
Asymptomatic in most of the cases, patients may present with and primarily for cosmetic reasons, she was counseled for
esthetic issues or symptoms of external auditory obstruction surgical excision of the lesion. The lesion proved to be a bony
[1, 4]. Computed tomography is the gold standard for diag- sessile mass extending from the lambdoid suture superiorly to
nosis [5]. The main aim of the radio imaging is to rule out C1 arch inferiorly (Figure 3). The lesion was excised with the
invasion of the inner table of the calvarium and its intracra- assist of a Gigli saw and later chiseled (Figure 4). The bleeding
nial extension of the lesion [1]. Complete excision in the from the base was controlled with the application of a bone
symptomatic and giant osteomas is the therapeutic goal [4]. wax. The mastoid air cells were not violated. The inner table
of the bone beneath was intact (Figure 5). The postoperative
period of the patient was uneventful and she was discharged
2. Case Report
on the third day. The histopathological study confirmed the
A fifty-five-year-old woman from Chitwan, Nepal, visited compact variant of benign osteoma. The patient followed up
our patient surgical outpatient clinic with a chief complaint in the OPD 2 months later. The scar was healthy and she had
of slowly progressive swelling at the back of her head. She no new complaints. She was assured and advised for a six-
had detected the swelling since her twenties. There was no month follow-up.
history of trauma, redness, ear discharge, deafness, or similar
swellings elsewhere in her body. It slowly progressed in 3. Discussion
size over time. Once it attained a massive size, she sought
medical advice. There were no important past medical or Osteoma is a slow-growing benign mesenchymal osteoblastic
surgical illnesses. Her bladder and bowel habits were normal. tumor formed by mature bone tissue [6]. Osteomas, consti-
Examination revealed a bony and sessile swelling on the right tuting 0.1–1% of all benign skull tumors, are extremely rare
suboccipital region and extending below the craniovertebral [7]. The most common site reported is the frontoethmoidal
junction (Figure 1). The skin overlying the lesion was normal. region and neighboring sinuses. Involvement of the temporal
The margin of the lesion was clearly demarcated. The cranial and occipital squama is extremely rare [8]. Osteomas larger
2 Case Reports in Neurological Medicine

Figure 3: Intraoperative picture outlining the lesion.

Figure 1: Image showing the extent of lesion and the planned
surgical incision mark.

Figure 4: The excised bony lesion.

Figure 2: CT bone window showing the large lesion in the right

suboccipital and adjacent mastoid region.

than 3 cm are termed giant osteomas [9]. They are also

common in the frontoethmoidal region with above 40 cases
reported in the literature [10, 11]. Only few cases of giant
osteomas involving the occipital region [2, 3], posterior skull
base [12], and the atlas [4] have been reported in the literature
so far.
Etiology of the entity includes trauma, previous surgery,
radiotherapy, chronic infection, and hormonal factors [13].
They may be a reliable marker for early detection of carriers
of Gardner syndrome [14]. They are mostly asymptomatic,
but they can present with deformity, swelling, pain, deafness,
and chronic discharge [15]. Computed tomography is the
imaging modality of choice which demonstrates a rounded Figure 5: The calvarial base after excision of the bony tumor.
Case Reports in Neurological Medicine 3

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4 Case Reports in Neurological Medicine

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