Frontal Masses: Diagnosis and Management

Introduction to Frontal Masses

The American Academy of Pediatrics recommends that frontonasal dermoid sinus tracts (DSTs) be recognized early due to their risk of intracranial infection, with 10-30% extending intracranially through the foramen cecum at the skull base 1
Frontal encephaloceles represent focal herniation of meninges with or without brain tissue through a skull defect and are most common among Asian populations 1

A critical diagnostic approach requires both CT and MRI for frontonasal DSTs, with CT revealing bony defects at the foramen cecum or intracranial calcifications, and MRI detecting soft tissue components and intracranial dermoid/epidermoid cysts 1
The American Academy of Otolaryngology-Head and Neck Surgery recommends a detailed history and physical examination for any frontal mass, including age of onset, growth rate, associated symptoms, and risk factors for malignancy 5
MRI with and without contrast is the primary modality for soft tissue characterization, intracranial extension, and relationship to critical structures, as recommended by the British journal of neurosurgery 2

Surgical excision is recommended for frontonasal DSTs regardless of imaging findings to prevent future complications including meningitis, subdural empyema, or brain abscess, as stated by the Pediatrics journal 1
Complete surgical resection is impossible for frontal gliomas due to their infiltrative nature, with tumor cells extending well beyond contrast-enhancing portions visible on imaging into the peritumoral edema, according to the Journal of the American College of Radiology 3
The British journal of neurosurgery recommends that tissue diagnosis be typically required for definitive diagnosis, with pathology guiding further management 2

Frontal convexity meningiomas appear isointense or hypointense on T1-weighted images and hyperintense on T2-weighted images with strong uniform contrast enhancement on MRI, as described by the British journal of neurosurgery 2
CT with bone windows is used to evaluate bony defects, calcifications, and hyperostosis, as recommended by the Pediatrics journal 1