PMC10235521_01
(A-C) Axial, sagittal, and coronary CT scans showed multiple hyperdense lesions without the involvement of bony structure. (D, E) 3D-CT skull reconstruction revealed the multiple lesions located within the cranial defects and internal fixations placed at the edge of the skull defect. (F) The postoperative 3D-CT skull reconstruction of the titanium mesh cranioplasty.
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CT scans showed partial defect of the left frontal skull with internal fixation shadow and multiple high-density nodules with a similar density as bone ( Figures 1A-C ). 3D-CT skull reconstruction revealed multiple lesions located within the left frontal cranial defects and three internal fixations placed at the edge of the cranial defects ( Figures 1D, E ). The patient received titanium mesh cranioplasty ( Figure 1F ).
(A-F) All the MRI sequences depicted the lesions' low signals.
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All the MRI sequences showed low signals ( Figure 2 ).
(A) The multiple irregular lesions were on the HAC flap with three internal fixations. (B, C) The lesions originated from the outer layer of the intact dura matter through the HAC holes (black arrows). (D, E) The HAC flap and the exposure of lesions in ventral area with roots. (F) Pathological diagnosis was osteoma hematoxylin and eosin (magnification, x200).
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The intraoperative findings disclosed that the multiple irregular lesions were nodular and hard and showed obvious ossification, and they were on the HAC flap ( Figures 3A, D ). The HAC was fixed by three internal fixations ( Figures 3A, B, D ). Intraoperatively, the lesions were found to originate from the surface of the dura mater and grew out through the reserved HAC holes, which were used to suspend the dura mater on the first surgery ( Figures 3B-D ). The lesions just adhered closely to the HAC surface without any attachment to the bony structure ( Figures 3A, D, E ). The dura matter was intact, and the roots of the lesions were given to cauterization ( Figure 3C ) (black arrows). Pathology suggested the diagnosis of osteoma ( Figure 3F ).
Timeline of the symptoms, management, and outcomes of the patient.
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The timeline of the symptoms, management, and outcomes of the patient are summarized in  Figure 4 .