This document reports on a rare case of parietal osteoma. A 56-year-old male presented with a spherical swelling on the left parietal bone. CT scan revealed a bony cyst eroding the parietal cortex. The patient underwent craniotomy and excision of the lesion, with reconstruction using titanium mesh. Post-operatively, the patient recovered well and was discharged on medications with no complications. Parietal osteoma is a rare benign bone tumor, usually growing on the skull. Surgical excision is the main treatment approach.

1. A RARE CASE ON PARIETAL OSTEOMA
1. ABSTRACT
An osteoma is a new piece of bone usually growing on another piece of
bone, typically the skull. It is a benign tumor. Osteoma in the occipital and
mastoid regions are exceptionally rare with only 137 cases reported in the
literature. Osteoma can occur in any part of the skull, in the frontal and
parietal rare, other skull and skull base is rare.
2. INTRODUCTION
Osteoma is a benign tumor characterized by slow growth, painless and
extensive growth. When the bone tumor grows on other bone it is known as
"homoplastic osteoma"; when it grows on other tissue it is called
"heteroplastic osteoma".Osteomarepresents the most benign neoplasm of the
nose and paranasal sinuses. The cause of osteoma is uncertain, but
commonly accepted theories propose embryologic, traumatic, or infectious
causes.
Parietal osteoma ( Cranial Osteoma) is divided into two major groups the
bony osteoma and the cancellous osteoma. The bone compact osteoma
mostly originates from the outer bone plate, and the inner plate remains
intact. Cancellous osteoma originated in fibrous tissue containing more
diploetic, and sometimes red bone marrow or bone marrow fat.
On the X-ray film of the skull, circular or oval shape and localized high-
density shadowcan be seen. The cancellous bone in the bone is loose and the
density is uneven. There is calcification in the trabecular bone. The osteoid
osteoma usually grows on the outer surface of the skull and rises outward,
and the internal structure is dense and even. In frontal and ethmoid sinus
osteoma often lobulated.
Diagnosis can be confirmed by CT Scan, Magnetic resonance imaging etc.
CT examination showed the skull bone changes, visible signs of
meningioma. It should be differentiated with fibrous hyperplasia of bone
lesions, the latter range widely, to see a face at the top of the orbit, changes
in the X-ray and CT showed full-thickness involvement of the skull,
boundary-less clear, the density is not the same, there may be other parts of
the body to change the blade.

2. The treatment of osteoma mainly depends on surgery. The osteoma of the
parietal cranium, such as small size, no special symptoms or a few stopped
growing osteoma, cannot be treated. Fast growing, affected faces and
symptomatic osteoma should be surgically removed. The osteoma which is
limited to the outer plate needs to be cut flat or polished, and the residual
substrate needs no electric cauterization. Osteoma with large intracranial
involvement should be removed by bone flap, and then the bone flap, 30min,
inactivation and plastic treatment will be performed. The involvement of
paranasal sinus osteoma such as paranasal sinus obstruction has caused
should be treated surgically, osteoma by subfrontal extradural approach
resection ethmoid osteoma by orbital or orbital plate surgical approaches.
Osteoma of cancellous bone needs total resection.
CASE REPORT
During my clinical posting in ABC hospital. I was Posted in neurological
ward. there I observed very a rare case diagnosed as Parietal osteoma., where
the patient has a swelling ( left parietal bony cyst eroding from the cortex of
skull ). The important significant clinical features includes
 Spherical shaped Swelling on left parietal cortical region
 Lesion on the cortex region.
 Generalized weakness
CECT REPORT
Left high parietal bony cysteroding to cortex of skull
FINAL DIAGNOSIS
Left parietal osteoma.
Mr ‘X ‘ 56 Years old got submitted to ABC hospital with the complaint of left
parietal bony cyst in cortical region. Craniotomy + excision of the lesion +
reconstruction using titanium mesh under GA on 30 / 04 /18was done. There
were no complications during intraoperative and postoperative period and
patient is on medications such as inj Celifna SB I.5 gm IV (BD), inj. Eptoin
100mg IV ( TID), inj. PCT 1 gm IV( BD), and Rantac 50 mg IV BD. Drain was
removed. Patient got discharged on 15 /05/2018.

3. Advice on Discharge
Tab. Eptoin 100 mg TID ( 2 Weeks)
Tab. Ultracet BD ( 5 days )
Tab. Rantac 150 mg ( 5 days )
The incidence of parietal osteoma reported in ABC Hospital in the year of
2017 was one
CASE DISCUSSION
Osteoma is benign tumor characterized by slow growth, painless and extensive
growth. The demarcation of the skull is often unclear. Can occur in any part of
the skull, in the frontal and parietal rare, other skull and skull base is rare.
Cranial osteoma is divided into two major groups the bony osteoma and the
cancellous osteoma. The bone compact osteoma mostly originates from the
outer bone plate, and the inner plate remains intact. Cancellous osteoma
originated in fibrous tissue containing more diploetic, and sometimes red bone
marrow or bone marrow fat. Diagnosis can be confirmed by CT Scan, Magnetic
resonance imaging etc. CT examination showed the skull bone changes at the
same time, visible signs of meningioma etc.

4. CONCLUSION
osteoma is a new piece of bone usually growing on another piece of bone,
typically the skull. It is a benign tumor. Osteoma can occur in any part of the
skull, frontal and parietal rare, other skull and skull base is rare. Management
measures mainly focus on surgical removal and replacing with bone flap. Proper
and Timely management can prevent life-threatening complications.
REFERENCE
1.BLACK M. JOYCE, Medical-Surgical Nursing, published by Elsevier,
Edition 8th, volume -2, page no :
2.Brunner and Suddarth’s, Textbookofmedical-surgical nursing, published by
Lippincott Williams and Wilkins, Edition 11th, volume 1, page no :
3.Lee YG, Cho CW. Benign osteoblastomalocated in the parietal bone. Journal
of Korean Neurosurgical Society. 2010 Aug;48(2):170.
4.http://www.aliub.com/what-is-the-skull-parietal-osteoma.
5. Quesnel AM, Lee DJ. Extensive osteomas of the temporal-parietal-occipital
skull. Otology & Neurotology. 2011 Jan 1;32(1):e3-4.