Adeloye–Odeku Disease: A Rare Anterior Fontanelle Inclusion Cyst in a Ghanaian Infant – Case Report and Literature Review

Adeloye–Odeku Disease: A Rare Anterior Fontanelle Inclusion Cyst in a Ghanaian Infant – Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Adeloye–Odeku Disease: A Rare Anterior Fontanelle Inclusion Cyst in a Ghanaian Infant – Case Report and Literature Review Hermas Saamaalme Paaga, Ebenezer Akomea-Agyin, Dickson Kwadwo Bandoh, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8473393/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Adeloye–Odeku disease, also known as anterior fontanelle inclusion cyst, is a rare congenital lesion commonly misdiagnosed as encephalocele. We present the first documented case in Ghana. Case presentation We present an 8-month-old female with a painless, progressively enlarging scalp swelling over the anterior fontanelle since birth. Examination revealed cystic swelling with no cough impulse that transilluminates with light. A computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) of the head revealed a well-defined, extradural located cystic mass without intracranial extension. Surgical excision was performed successfully, and histopathology confirmed a dermoid cyst. Conclusion Adeloye–Odeku disease has been reported globally. It is commonly misdiagnosed as encephalocele. Diagnosis can be achieved with non-invasive imaging techniques, and total surgical excision is curative with great prognosis. Adeloye–Odeku disease Anterior fontanelle Inclusion cyst Dermoid cyst Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Congenital inclusion cysts of the subgaleal space have been described in various parts of the scalp. These include the anterior fontanelle, left and right frontal regions near the pterion and even the posterior fontanelle ( 1 , 2 ). Anterior fontanelle inclusion cysts have been well documented though rare, and credited to two neurosurgeons from Nigeria, Adelola Adeloye and Latunde Odeku who first described 18 cases of congenital dermoid cysts located over the anterior fontanelle ( 3 ). Initially thought to be an African disease, the distribution of the disease is now considered more global as cases have been reported in all continents ( 1 , 4 – 10 ). It is important to distinguish anterior fontanelle inclusion cyst from other similar lesions that represent greater surgical complexity, morbidity, and mortality such as meningoencephalocele and encephalocele ( 4 ). This distinction can be made through imaging studies such as Computed Tomography (CT) scanning and Magnetic Resonance Imaging (MRI) which rule out intracranial extension of the cyst ( 11 ). The risk of encountering such differentials has over the years made this condition primarily managed by Neurosurgeons. The treatment of choice remains complete surgical excision. Case presentation An 8-month-old female infant presented with a large frontal mass noted since birth. The parents brought the child due to cosmetic embarrassment for medical care after failed herbal care. The child was delivered via spontaneous vaginal delivery. The mass gradually increased in size over the course of 8 months. There was no perinatal history of trauma, fever, seizures, or developmental delay. The mother had an uneventful perinatal period. Examination revealed a well-hydrated, afebrile, conscious and playful child (PGCS 15/15) with stable vital signs recorded throughout admission (Temp ~ 36°C, HR 76–136 bpm, SpO₂ 98–100%). He had a large 13 x 14cm mass over anterior fontanelle that was cystic, fluctuant, non-tender with no signs of inflammation and transilluminated light (Figs. 1 a and 1 b). The respiratory, cardiovascular, and abdominal examinations were unremarkable. No neurological deficits were observed. Laboratory investigations done included a full blood count, renal function tests, and clotting profile, all of which were in normal ranges. The diagnosis entertained at the time was a frontal encephalocele. A CT scan initially done outside the hospital facility suggested a frontal encephalocele, though after discussion with radiologist in hindsight revealed a subgaleal mass with no intracranial extension or enhancement post contrast (Figs. 2 a and 2 b). An MRI scan showed a well-defined T2 weighted hyper-intense scalp mass over the anterior fontanelle without an intracranial extension (Figs. 3 a and 3 b). The diagnosis was modified to an anterior fontanelle inclusion cyst. A complete surgical excision of a cystic lesion was done through a bicoronal skin incision and dissection of the mass en bloc (Figs. 4 a, 4 b, 4 c, and 5 ). Closure was in layers with absorbable sutures (Fig. 4 d). Histopathology results showed a 7cm x 4cm cystic lesion (Fig. 5 ) with wall lined by squamous epithelium, focal sebaceous glands, and keratinous material. There was no evidence of malignancy. The child had an uneventful recovery managed on analgesia, antibiotics, and intravenous fluids. She was discharged with no post-operative neurological deficits. The follow up to a year showed no recurrence, and the parents of the child were very satisfied with the aesthetic outcome. Discussion Adeloye–Odeku disease was first described in 1971 and named after the two neurosurgeons from Nigeria, Adelola Adeloye and Latunde Odeku who first described it. They described 18 cases of congenital dermoid cysts located over the anterior fontanelle ( 3 ). The disease was initially considered exclusive to African children, but subsequent reports, documented cases globally, including in Asia, North America, South America, and Europe ( 1 , 4 – 10 ). The condition, however, remains rare. We present what we believe to be the first reported case in Ghana. Epidemiologically, Adeloye–Odeku disease accounts for approximately 0.2% of all inclusion cysts ( 7 ). It forms about 26.6% of dermoid cysts of the skull, making it the most common site for presentation on the skull ( 12 ). It shows a female predominance with ratio approximated at 2:1 ( 1 , 3 , 12 , 13 ). Similar to our case the infant was a female. The pathogenesis arises from disorders of embryogenesis, making it predominantly an infantile presentation in about two-thirds of patients ( 3 , 12 , 14 ). There are however reported cases in adults due to late presentation ( 14 , 15 ). The cyst originates from the inclusion of the epithelium or dermal structures along the midline of the neuroaxis between the third and fifth week of embryogenesis when the ectoderm folds towards the center of the neural tube ( 14 ). It presents at birth and gradually enlarges due to cellular proliferation and desquamation of keratinized debris into the center of the cyst ( 1 , 7 ). Clinically, a patient typically presents a swelling over the anterior fontanelle discovered at birth, which gradually enlarges in size without developmental delays or neurological symptoms. There are usually no positive family history of similar swelling and no associated congenital anomalies. The swelling is usually a spherical, solitary, well-defined mass, measuring between 1cm to 7cm. It is non-tender, soft in consistency, fluctuant, non-compressible, non-pulsatile, and transilluminates to light. It has an intact, mobile overlying skin with no gross changes. This presentation may have variations in a few instances ( 1 , 3 , 4 , 6 , 7 , 9 , 10 , 12 , 13 , 16 ). Our patient, though an infant, presented a much larger lesion measuring 13cm x 14cm on clinical examination. It had similar cystic features described in most literature with no neurological symptoms or developmental delays. Non-invasive procedures in the form of imaging are adequate to diagnose Adeloye–Odeku disease. There is no diagnostic or therapeutic benefit to invasive procedures such as cyst aspiration and lumbar puncture ( 9 , 12 ). Imaging modalities of choice is between Computed Tomography scan and Magnetic Resonance Imaging ( 7 , 8 , 11 , 14 ). These are needed to confirm the extradural confined nature of the cyst and to rule out intracranial involvement. The debate on which of the two imaging modalities is superior is mainly based on their individual radiological advantages and disadvantages ( 5 , 7 , 11 ). We believe the choice should be made on a case-to-case basis, considering patient factors, availability and experience of radiologists to interpret the findings that will exclude intracranial extension and other major differentials. Other imaging investigations that can augment the diagnosis of Adeloye–Odeku disease or used in the absence of the above investigations include plain X-Rays of the skull and ultrasound. X-rays may show erosion and the flattening or depression of the skull bone underneath the lesion. Intracranial extension can be excluded on X-ray only if the fontanelle is closed in which case, it will show a complete outer skull table with overlying soft tissue shadow ( 1 , 7 , 9 ). The ultrasound scan with doppler will not only show features of the lesion but verify the absence of blood flow in the lesion ( 13 , 14 , 17 ). In our case, the CT scan initially ruled out intracranial extension but for the misinterpretation by the first radiologist. This led to a need for further investigation with an MRI scan. Differential diagnoses include encephalocele, lipoma, sebaceous cyst, subgaleal hematoma, cephalhematoma, sinus pericranii, cystic hygroma, cavernous angioma, lymphangioma, hemangioma, bone tumors, eosinophilic granuloma, growing fracture, heterotopic brain tissue, meningioma, myxopapillary ependymoma, and melanotic progonoma, all of which rarely occur over the anterior fontanelle ( 1 , 3 , 4 , 6 , 7 , 9 , 10 , 17 ). The commonest misdiagnosis is encephalocele, which leads to frequent referrals of these patients to the neurosurgeon. In our case, encephalocele was the initial diagnosis. Initial CT scan interpretation also suggested the same. Complete surgical excision is the treatment of choice, with excellent prognosis when complete excision of cyst is achieved. There is almost no recurrence reported. Incisional approaches described include elliptical incision across the summit of the lesion, transverse scalp incision, coronal incision, skin crease incision over the lesion, medial sagittal incision over the lesion, and semicircular incision ( 1 , 3 , 5 – 7 , 10 , 13 , 16 ). A coronal incision was used in our case due to the large size of the lesion and consideration of an encephalocele as a differential diagnosis. Histopathology differentiates the more common dermoid cyst from the much rare epidermoid cysts by the presence of skin appendages such as hair follicles, sweat and sebaceous glands in the dermoid cysts. The epidermoid cyst lacks these appendages ( 7 , 14 , 16 ). Some literature further describes the biochemical components and their proportions of the fluid in the cyst. The fluid color ranges from clear (like cerebrospinal fluid) to yellowish and turbid. It has varied amounts of protein, glucose, potassium, sodium, urea, lactate dehydrogenase (LDH), amylase, and cholesterol crystals ( 1 , 3 , 5 , 13 ). Adeloye and Odeku reported detecting clear fluid with low protein and glucose levels in smaller cysts, but yellowish fluid with high levels of protein and glucose were seen in larger cysts. What defines larger and smaller cysts ( 8 , 11 ) is not clear from literature, and these findings are yet to be largely replicated ( 3 ). The significance of the characteristics of the fluid components may reflect the histologic nature of the lining cells and the mechanism of their secretion ( 1 ). It currently has no significant diagnostic or therapeutic advantage. Aspiration of the cyst prior to surgical excision for diagnostic or therapeutic purposes is frowned upon. The former leads to infection and the latter leads to recurrence ( 1 , 8 , 14 ). In our case, fluid analysis was not done. Prognosis is good for Adeloye–Odeku disease. Patients usually present due to cosmetic embarrassment. Treatment is mainly for cosmesis and to obtain histological diagnosis but also to prevent possible complications such as infection ( 8 , 9 , 11 ). Though there are a few cases of inclusion cysts that underwent malignant change, none have been reported for subgaleal cyst ( 1 , 7 , 14 ). Conclusion Adeloye–Odeku disease has been reported globally. It is commonly misdiagnosed as encephalocele. Diagnosis can be achieved with non-invasive imaging techniques, and total surgical excision is curative with great prognosis. Abbreviations CT Computed tomography MRI Magnetic Resonance Imaging pGCS Pediatric Glasgow Coma Scale LDH lactate dehydrogenase Declarations Ethics approval and consent to participate Ethical approval was waived at our institution, the Tamale Teaching Hospital Ethical Review Committee (TTH ERC). The ethical review waives ethical approval of case reports as patient identification is not revealed and would not be harmful to the patient. Consent for publication Written informed consent was obtained from the parents of the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request. Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Author Contribution HSP conceptualized the study and was involved in patient care. EAA drafted, edited, and critically revised the manuscript. DKB supervised the work and edited the manuscript. MMD, OI, and AAM were involved in patient care and contributed to data acquisition. All authors read and approved the final manuscript. Acknowledgements Not applicable Clinical trial number: not applicable Availability of data and materials Data sharing is not applicable to this article as no datasets were generated or analysed during the current study Competing interests The authors declare that they have no competing interests References Chaudhari AB, Rosenthal AD, Lipper S. Congenital inclusion cysts of the subgaleal space. Surg Neurol [Internet]. 1984 Jan 1 [cited 2025 Oct 31];21(1):61–6. Available from: https://www.sciencedirect.com/science/article/abs/pii/0090301984904038 Pereira C, Serejo N, Costa S, Cardoso D, Matis G, Silva D. Congenital inclusion dermoid cyst of the Posterior fontanel - A case report. 2012. Adeloye A, Odeku EL. Congenital subgaleal cysts over the anterior fontanelle in Nigerians. Arch Dis Child. 1971;46(245):95–8. Dadlani R, Furtado S, Ghosal N, Hegde A. Adeloye-Odeku disease: an African disease in the Indian child? Turk Neurosurg [Internet]. 2012 [cited 2025 Oct 27];22(4):515–20. Available from: https://pubmed.ncbi.nlm.nih.gov/22843479/ Al-Gahtany M, Binitie O, ADELOYE-ODEKU DISEASE IN ASEER, REGION OF SAUDI ARABIA. J West Afr Coll Surg [Internet]. 2011 Oct 6 [cited 2025 May 4];1(1):113. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4170255/ Agrawal A, Pratap A, Sinha AK, Agrawal B, Thapa A, Bajracharya T. Epidermoid cyst of anterior fontanelle with clear contents. Surg Neurol [Internet]. 2007 Sep [cited 2025 May 4];68(3):313–5. Available from: https://pubmed.ncbi.nlm.nih.gov/17719978/ De Carvalho GTC, Fagundes-Pereyra WJ, Marques JAP, Dantas FLR, De Sousa AA. Congenital inclusion cysts of the anterior fontanelle. Surg Neurol [Internet]. 2001 Dec 1 [cited 2025 Oct 31];56(6):400–5. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0090301901006218 Kanamaru K, Waga S. Congenital dermoid cyst of the anterior fontanel in a japanese infant. Surg Neurol [Internet]. 1984 Mar 1 [cited 2025 Nov 2];21(3):287–90. Available from: https://www.sciencedirect.com/science/article/pii/0090301984902040 Stella L, Spaziante R, Maiuri F, Gangemi M, de Divitiis E. Congenital dermoid cysts at the anterior fontanelle. Report of three cases in Italian children. Neurochirurgia (Stuttg) [Internet]. 1984 Nov [cited 2025 Nov 2];27(6):186–9. Available from: https://pubmed.ncbi.nlm.nih.gov/6514083/ Pařízek J, Němeček S, Němečková J, Černoch Z, Šercl M. Congenital dermoid cysts over the anterior fontanel. Report on 13 cases in Czechoslovak children. Childs Nerv Syst [Internet]. 1989 [cited 2025 Nov 2];5(4):234–7. Available from: https://pubmed.ncbi.nlm.nih.gov/2676162/ Saito M, Takagi T, Ishikawa T. Dermoid cyst of the anterior fontanel: Advantage of MM for the diagnosis. Brain Dev [Internet]. 1988 Jan 1 [cited 2025 Nov 2];10(4):252–5. Available from: https://www.sciencedirect.com/science/article/pii/S038776048880007X Pannell BW, Hendrick EB, Hoffmann HJ, Humphreys RP. Dermoid cysts of the anterior fontanelle. Neurosurgery [Internet]. 1982 [cited 2025 Nov 4];10(3):317–23. Available from: https://pubmed.ncbi.nlm.nih.gov/7070634/ Morgan E, Okwumezie CO, Akasike GC, Morgan EA. Adeloye-Odeku Disease in Irrua, South-South Nigeria: The experience so far in a rural neurosurgical setting. Romanian Neurosurgery [Internet]. 2019 Dec 16 [cited 2025 Feb 21];431–7. Available from: https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/1274 Obanife OH, Ashindointiang J. Adeloye-Odeku cyst in a 65-year-old man, a rare presentation of a very rare disease: Case report and literature review. Interdisciplinary Neurosurg. 2021;23:100971. De Castro RAG, Ribeiro Filho ADS, Da Silva VV. Dermoid cyst of the anterior fontanelle in adults: Case report. Arq Neuropsiquiatr [Internet]. 2007 [cited 2025 Nov 2];65(1):170–2. Available from: https://www.researchgate.net/publication/6401550_Dermoid_cyst_of_the_anterior_fontanelle_in_adults_Case_report Ridho Husodo K, Suryonurafif A. No Longer an African Child’s Disease: The First Indonesian Case Report of Adeloye-Odeku Disease, A Rare Anterior Fontanelle Cyst. Malaysian J Med Health Sci. 2024;20(4):403–6. Ponce-Ayala A, de Llano JNG, Degollado-Garcia J, Hernández-Álvarez N, Mendizabal-Guerra R, Ayala AP et al. Anterior Fontanelle Dermoid Cyst: Surgical Technique. Cureus [Internet]. 2021 Jul 12 [cited 2025 Nov 2];13(7). Available from: https://cureus.com/articles/63969-anterior-fontanelle-dermoid-cyst-surgical-technique Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8473393","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":587615385,"identity":"b58ccc64-8d46-4480-a919-8bb99390f9e4","order_by":0,"name":"Hermas Saamaalme Paaga","email":"","orcid":"","institution":"Tamale Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hermas","middleName":"Saamaalme","lastName":"Paaga","suffix":""},{"id":587615386,"identity":"022b7b73-46fa-47e2-961f-4f8a24a0a670","order_by":1,"name":"Ebenezer Akomea-Agyin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIie2QsQrCMBCGTwJxCWSNWH2GQqAIDuKbWIRO6RvU4pRJ6trNV3ByVoJx0b17wcGpUHAsprq3dRPMN9wR+D/uLgAWyy+DAR1NY843Cl7UCvlmDnHftTVHqdIFRCs/GW7KRxZNCPTVed+kDNZ6mYK++NK5HaZCm8VIEGRNinvacHOI9iULD1xgozDiNSozRUuAqlbEnYuqg+JigqAno1pBeSg7KOyKOfjJkUsWeChMGMFtt9CtyqF4xqNdusxL8YzHtK90o/JmAWq+Np/A6gdujX+IZ6agomPaYrFY/owXZdBDWC6r1BsAAAAASUVORK5CYII=","orcid":"","institution":"Komfo Anokye Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ebenezer","middleName":"","lastName":"Akomea-Agyin","suffix":""},{"id":587615387,"identity":"4e445ed2-4df0-49ff-a008-b0f23b80a402","order_by":2,"name":"Dickson Kwadwo Bandoh","email":"","orcid":"","institution":"Tamale Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dickson","middleName":"Kwadwo","lastName":"Bandoh","suffix":""},{"id":587615388,"identity":"328739a2-63ce-4b34-b31c-b8ae5edfbbde","order_by":3,"name":"Malcolm Mambuoraa Dery","email":"","orcid":"","institution":"Tamale Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Malcolm","middleName":"Mambuoraa","lastName":"Dery","suffix":""},{"id":587615389,"identity":"36ee2bf1-a662-46c4-ad50-da2e3f8cb6f6","order_by":4,"name":"Okasha Issaka","email":"","orcid":"","institution":"Tamale Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Okasha","middleName":"","lastName":"Issaka","suffix":""},{"id":587615390,"identity":"0dd58a3f-a148-488c-97b5-48402d6d7bc2","order_by":5,"name":"Abdul-Aziz Mahama","email":"","orcid":"","institution":"Tamale Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abdul-Aziz","middleName":"","lastName":"Mahama","suffix":""}],"badges":[],"createdAt":"2025-12-29 13:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8473393/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8473393/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102337283,"identity":"1bf53919-6011-4aaa-ba7c-1a804e2e71b7","added_by":"auto","created_at":"2026-02-10 16:12:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":914932,"visible":true,"origin":"","legend":"\u003cp\u003eShows the position and extent of the lesion clinically\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8473393/v1/5a91fbad91dd526416c2c223.png"},{"id":102398165,"identity":"72cb5972-93e1-4505-b74f-29a3b3d98392","added_by":"auto","created_at":"2026-02-11 10:21:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":562562,"visible":true,"origin":"","legend":"\u003cp\u003eNon contrast head CT scan showing sagittal and coronal views\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8473393/v1/30b526f76e4ca2f1d061bf21.png"},{"id":102337105,"identity":"7a257fde-8bae-4b25-9759-0ba94f44cdc0","added_by":"auto","created_at":"2026-02-10 16:11:51","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":651133,"visible":true,"origin":"","legend":"\u003cp\u003eCoronal T2 weighted images showing subgaleal cyst over the anterior fontanelle without intracranial extension.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8473393/v1/ab40c51d5406241941628bc1.png"},{"id":102337108,"identity":"bcb69106-ca9d-46c9-a61d-962f9b3cc72c","added_by":"auto","created_at":"2026-02-10 16:11:52","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1410206,"visible":true,"origin":"","legend":"\u003cp\u003eIntraoperative images showing dissection and excision of cyst through a bicoronal incison (a, b). Closure of incision was done after cyst excision (c, d).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8473393/v1/8018eef70965c5eba4128f7f.png"},{"id":102337103,"identity":"c15cf2a4-8c16-42ca-9b9f-05ba18cfef72","added_by":"auto","created_at":"2026-02-10 16:11:51","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":271729,"visible":true,"origin":"","legend":"\u003cp\u003eCyst dissected en bloc.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8473393/v1/b7b0d38afa26b92138dfd5d1.png"},{"id":102399197,"identity":"3bfb3cd2-1a45-4772-bfad-88fd2003ac7f","added_by":"auto","created_at":"2026-02-11 10:33:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":6188854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8473393/v1/122d3efc-1f0c-4cc4-9b16-ec1877a3181d.pdf"},{"id":102337121,"identity":"e712624b-c7c3-4229-9b08-948ddf550bc6","added_by":"auto","created_at":"2026-02-10 16:11:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1855274,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklistEnglish2013.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8473393/v1/8cb520d6ac22ae8d61a8874c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eAdeloye–Odeku Disease: A Rare Anterior Fontanelle Inclusion Cyst in a Ghanaian Infant – Case Report and Literature Review\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eCongenital inclusion cysts of the subgaleal space have been described in various parts of the scalp. These include the anterior fontanelle, left and right frontal regions near the pterion and even the posterior fontanelle (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Anterior fontanelle inclusion cysts have been well documented though rare, and credited to two neurosurgeons from Nigeria, Adelola Adeloye and Latunde Odeku who first described 18 cases of congenital dermoid cysts located over the anterior fontanelle (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Initially thought to be an African disease, the distribution of the disease is now considered more global as cases have been reported in all continents (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is important to distinguish anterior fontanelle inclusion cyst from other similar lesions that represent greater surgical complexity, morbidity, and mortality such as meningoencephalocele and encephalocele (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). This distinction can be made through imaging studies such as Computed Tomography (CT) scanning and Magnetic Resonance Imaging (MRI) which rule out intracranial extension of the cyst (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The risk of encountering such differentials has over the years made this condition primarily managed by Neurosurgeons. The treatment of choice remains complete surgical excision.\u003c/p\u003e "},{"header":"Case presentation","content":"\u003cp\u003eAn 8-month-old female infant presented with a large frontal mass noted since birth. The parents brought the child due to cosmetic embarrassment for medical care after failed herbal care. The child was delivered via spontaneous vaginal delivery. The mass gradually increased in size over the course of 8 months. There was no perinatal history of trauma, fever, seizures, or developmental delay. The mother had an uneventful perinatal period. Examination revealed a well-hydrated, afebrile, conscious and playful child (PGCS 15/15) with stable vital signs recorded throughout admission (Temp ~ 36°C, HR 76–136 bpm, SpO₂ 98–100%). He had a large 13 x 14cm mass over anterior fontanelle that was cystic, fluctuant, non-tender with no signs of inflammation and transilluminated light (Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea and \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb). The respiratory, cardiovascular, and abdominal examinations were unremarkable. No neurological deficits were observed. Laboratory investigations done included a full blood count, renal function tests, and clotting profile, all of which were in normal ranges. The diagnosis entertained at the time was a frontal encephalocele. A CT scan initially done outside the hospital facility suggested a frontal encephalocele, though after discussion with radiologist in hindsight revealed a subgaleal mass with no intracranial extension or enhancement post contrast (Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb). An MRI scan showed a well-defined T2 weighted hyper-intense scalp mass over the anterior fontanelle without an intracranial extension (Figs.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003ea and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eb). The diagnosis was modified to an anterior fontanelle inclusion cyst. A complete surgical excision of a cystic lesion was done through a bicoronal skin incision and dissection of the mass en bloc (Figs.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ea, \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eb, \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ec, and \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Closure was in layers with absorbable sutures (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003ed). Histopathology results showed a 7cm x 4cm cystic lesion (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) with wall lined by squamous epithelium, focal sebaceous glands, and keratinous material. There was no evidence of malignancy. The child had an uneventful recovery managed on analgesia, antibiotics, and intravenous fluids. She was discharged with no post-operative neurological deficits. The follow up to a year showed no recurrence, and the parents of the child were very satisfied with the aesthetic outcome.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAdeloye\u0026ndash;Odeku disease was first described in 1971 and named after the two neurosurgeons from Nigeria, Adelola Adeloye and Latunde Odeku who first described it. They described 18 cases of congenital dermoid cysts located over the anterior fontanelle (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The disease was initially considered exclusive to African children, but subsequent reports, documented cases globally, including in Asia, North America, South America, and Europe (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). The condition, however, remains rare. We present what we believe to be the first reported case in Ghana.\u003c/p\u003e \u003cp\u003eEpidemiologically, Adeloye\u0026ndash;Odeku disease accounts for approximately 0.2% of all inclusion cysts (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). It forms about 26.6% of dermoid cysts of the skull, making it the most common site for presentation on the skull (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). It shows a female predominance with ratio approximated at 2:1 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Similar to our case the infant was a female.\u003c/p\u003e \u003cp\u003eThe pathogenesis arises from disorders of embryogenesis, making it predominantly an infantile presentation in about two-thirds of patients (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). There are however reported cases in adults due to late presentation (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The cyst originates from the inclusion of the epithelium or dermal structures along the midline of the neuroaxis between the third and fifth week of embryogenesis when the ectoderm folds towards the center of the neural tube (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). It presents at birth and gradually enlarges due to cellular proliferation and desquamation of keratinized debris into the center of the cyst (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClinically, a patient typically presents a swelling over the anterior fontanelle discovered at birth, which gradually enlarges in size without developmental delays or neurological symptoms. There are usually no positive family history of similar swelling and no associated congenital anomalies. The swelling is usually a spherical, solitary, well-defined mass, measuring between 1cm to 7cm. It is non-tender, soft in consistency, fluctuant, non-compressible, non-pulsatile, and transilluminates to light. It has an intact, mobile overlying skin with no gross changes. This presentation may have variations in a few instances (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Our patient, though an infant, presented a much larger lesion measuring 13cm x 14cm on clinical examination. It had similar cystic features described in most literature with no neurological symptoms or developmental delays.\u003c/p\u003e \u003cp\u003eNon-invasive procedures in the form of imaging are adequate to diagnose Adeloye\u0026ndash;Odeku disease. There is no diagnostic or therapeutic benefit to invasive procedures such as cyst aspiration and lumbar puncture (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Imaging modalities of choice is between Computed Tomography scan and Magnetic Resonance Imaging (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). These are needed to confirm the extradural confined nature of the cyst and to rule out intracranial involvement. The debate on which of the two imaging modalities is superior is mainly based on their individual radiological advantages and disadvantages (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). We believe the choice should be made on a case-to-case basis, considering patient factors, availability and experience of radiologists to interpret the findings that will exclude intracranial extension and other major differentials. Other imaging investigations that can augment the diagnosis of Adeloye\u0026ndash;Odeku disease or used in the absence of the above investigations include plain X-Rays of the skull and ultrasound. X-rays may show erosion and the flattening or depression of the skull bone underneath the lesion. Intracranial extension can be excluded on X-ray only if the fontanelle is closed in which case, it will show a complete outer skull table with overlying soft tissue shadow (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The ultrasound scan with doppler will not only show features of the lesion but verify the absence of blood flow in the lesion (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In our case, the CT scan initially ruled out intracranial extension but for the misinterpretation by the first radiologist. This led to a need for further investigation with an MRI scan.\u003c/p\u003e \u003cp\u003eDifferential diagnoses include encephalocele, lipoma, sebaceous cyst, subgaleal hematoma, cephalhematoma, sinus pericranii, cystic hygroma, cavernous angioma, lymphangioma, hemangioma, bone tumors, eosinophilic granuloma, growing fracture, heterotopic brain tissue, meningioma, myxopapillary ependymoma, and melanotic progonoma, all of which rarely occur over the anterior fontanelle (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The commonest misdiagnosis is encephalocele, which leads to frequent referrals of these patients to the neurosurgeon. In our case, encephalocele was the initial diagnosis. Initial CT scan interpretation also suggested the same.\u003c/p\u003e \u003cp\u003eComplete surgical excision is the treatment of choice, with excellent prognosis when complete excision of cyst is achieved. There is almost no recurrence reported. Incisional approaches described include elliptical incision across the summit of the lesion, transverse scalp incision, coronal incision, skin crease incision over the lesion, medial sagittal incision over the lesion, and semicircular incision (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A coronal incision was used in our case due to the large size of the lesion and consideration of an encephalocele as a differential diagnosis.\u003c/p\u003e \u003cp\u003eHistopathology differentiates the more common dermoid cyst from the much rare epidermoid cysts by the presence of skin appendages such as hair follicles, sweat and sebaceous glands in the dermoid cysts. The epidermoid cyst lacks these appendages (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Some literature further describes the biochemical components and their proportions of the fluid in the cyst. The fluid color ranges from clear (like cerebrospinal fluid) to yellowish and turbid. It has varied amounts of protein, glucose, potassium, sodium, urea, lactate dehydrogenase (LDH), amylase, and cholesterol crystals (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Adeloye and Odeku reported detecting clear fluid with low protein and glucose levels in smaller cysts, but yellowish fluid with high levels of protein and glucose were seen in larger cysts. What defines larger and smaller cysts (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) is not clear from literature, and these findings are yet to be largely replicated (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The significance of the characteristics of the fluid components may reflect the histologic nature of the lining cells and the mechanism of their secretion (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). It currently has no significant diagnostic or therapeutic advantage. Aspiration of the cyst prior to surgical excision for diagnostic or therapeutic purposes is frowned upon. The former leads to infection and the latter leads to recurrence (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). In our case, fluid analysis was not done.\u003c/p\u003e \u003cp\u003ePrognosis is good for Adeloye\u0026ndash;Odeku disease. Patients usually present due to cosmetic embarrassment. Treatment is mainly for cosmesis and to obtain histological diagnosis but also to prevent possible complications such as infection (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Though there are a few cases of inclusion cysts that underwent malignant change, none have been reported for subgaleal cyst (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eAdeloye\u0026ndash;Odeku disease has been reported globally. It is commonly misdiagnosed as encephalocele. Diagnosis can be achieved with non-invasive imaging techniques, and total surgical excision is curative with great prognosis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMagnetic Resonance Imaging\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003epGCS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePediatric Glasgow Coma Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLDH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elactate dehydrogenase\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e \u003cp\u003eEthical approval was waived at our institution, the Tamale Teaching Hospital Ethical Review Committee (TTH ERC). The ethical review waives ethical approval of case reports as patient identification is not revealed and would not be harmful to the patient.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eWritten informed consent was obtained from the parents of the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHSP conceptualized the study and was involved in patient care. EAA drafted, edited, and critically revised the manuscript. DKB supervised the work and edited the manuscript. MMD, OI, and AAM were involved in patient care and contributed to data acquisition. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable\u003c/p\u003e \u003cp\u003eClinical trial number: not applicable\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eData sharing is not applicable to this article as no datasets were generated or analysed during the current study\u003c/p\u003e \u003cp\u003eCompeting interests\u003c/p\u003e \u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChaudhari AB, Rosenthal AD, Lipper S. Congenital inclusion cysts of the subgaleal space. Surg Neurol [Internet]. 1984 Jan 1 [cited 2025 Oct 31];21(1):61\u0026ndash;6. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/abs/pii/0090301984904038\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/abs/pii/0090301984904038\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePereira C, Serejo N, Costa S, Cardoso D, Matis G, Silva D. Congenital inclusion dermoid cyst of the Posterior fontanel - A case report. 2012.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdeloye A, Odeku EL. Congenital subgaleal cysts over the anterior fontanelle in Nigerians. Arch Dis Child. 1971;46(245):95\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDadlani R, Furtado S, Ghosal N, Hegde A. Adeloye-Odeku disease: an African disease in the Indian child? Turk Neurosurg [Internet]. 2012 [cited 2025 Oct 27];22(4):515\u0026ndash;20. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/22843479/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/22843479/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAl-Gahtany M, Binitie O, ADELOYE-ODEKU DISEASE IN ASEER, REGION OF SAUDI ARABIA. J West Afr Coll Surg [Internet]. 2011 Oct 6 [cited 2025 May 4];1(1):113. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pmc.ncbi.nlm.nih.gov/articles/PMC4170255/\u003c/span\u003e\u003cspan address=\"https://pmc.ncbi.nlm.nih.gov/articles/PMC4170255/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgrawal A, Pratap A, Sinha AK, Agrawal B, Thapa A, Bajracharya T. Epidermoid cyst of anterior fontanelle with clear contents. Surg Neurol [Internet]. 2007 Sep [cited 2025 May 4];68(3):313\u0026ndash;5. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/17719978/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/17719978/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Carvalho GTC, Fagundes-Pereyra WJ, Marques JAP, Dantas FLR, De Sousa AA. Congenital inclusion cysts of the anterior fontanelle. Surg Neurol [Internet]. 2001 Dec 1 [cited 2025 Oct 31];56(6):400\u0026ndash;5. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/abs/pii/S0090301901006218\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/abs/pii/S0090301901006218\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanamaru K, Waga S. Congenital dermoid cyst of the anterior fontanel in a japanese infant. Surg Neurol [Internet]. 1984 Mar 1 [cited 2025 Nov 2];21(3):287\u0026ndash;90. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/0090301984902040\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/0090301984902040\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStella L, Spaziante R, Maiuri F, Gangemi M, de Divitiis E. Congenital dermoid cysts at the anterior fontanelle. Report of three cases in Italian children. Neurochirurgia (Stuttg) [Internet]. 1984 Nov [cited 2025 Nov 2];27(6):186\u0026ndash;9. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/6514083/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/6514083/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePař\u0026iacute;zek J, Němeček S, Němečkov\u0026aacute; J, Černoch Z, Šercl M. Congenital dermoid cysts over the anterior fontanel. Report on 13 cases in Czechoslovak children. Childs Nerv Syst [Internet]. 1989 [cited 2025 Nov 2];5(4):234\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/2676162/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/2676162/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaito M, Takagi T, Ishikawa T. Dermoid cyst of the anterior fontanel: Advantage of MM for the diagnosis. Brain Dev [Internet]. 1988 Jan 1 [cited 2025 Nov 2];10(4):252\u0026ndash;5. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.sciencedirect.com/science/article/pii/S038776048880007X\u003c/span\u003e\u003cspan address=\"https://www.sciencedirect.com/science/article/pii/S038776048880007X\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePannell BW, Hendrick EB, Hoffmann HJ, Humphreys RP. Dermoid cysts of the anterior fontanelle. Neurosurgery [Internet]. 1982 [cited 2025 Nov 4];10(3):317\u0026ndash;23. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/7070634/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/7070634/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorgan E, Okwumezie CO, Akasike GC, Morgan EA. Adeloye-Odeku Disease in Irrua, South-South Nigeria: The experience so far in a rural neurosurgical setting. Romanian Neurosurgery [Internet]. 2019 Dec 16 [cited 2025 Feb 21];431\u0026ndash;7. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.lapub.co.uk/index.php/roneurosurgery/article/view/1274\u003c/span\u003e\u003cspan address=\"https://journals.lapub.co.uk/index.php/roneurosurgery/article/view/1274\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eObanife OH, Ashindointiang J. Adeloye-Odeku cyst in a 65-year-old man, a rare presentation of a very rare disease: Case report and literature review. Interdisciplinary Neurosurg. 2021;23:100971.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Castro RAG, Ribeiro Filho ADS, Da Silva VV. Dermoid cyst of the anterior fontanelle in adults: Case report. Arq Neuropsiquiatr [Internet]. 2007 [cited 2025 Nov 2];65(1):170\u0026ndash;2. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.researchgate.net/publication/6401550_Dermoid_cyst_of_the_anterior_fontanelle_in_adults_Case_report\u003c/span\u003e\u003cspan address=\"https://www.researchgate.net/publication/6401550_Dermoid_cyst_of_the_anterior_fontanelle_in_adults_Case_report\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRidho Husodo K, Suryonurafif A. No Longer an African Child\u0026rsquo;s Disease: The First Indonesian Case Report of Adeloye-Odeku Disease, A Rare Anterior Fontanelle Cyst. Malaysian J Med Health Sci. 2024;20(4):403\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePonce-Ayala A, de Llano JNG, Degollado-Garcia J, Hern\u0026aacute;ndez-\u0026Aacute;lvarez N, Mendizabal-Guerra R, Ayala AP et al. Anterior Fontanelle Dermoid Cyst: Surgical Technique. Cureus [Internet]. 2021 Jul 12 [cited 2025 Nov 2];13(7). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://cureus.com/articles/63969-anterior-fontanelle-dermoid-cyst-surgical-technique\u003c/span\u003e\u003cspan address=\"https://cureus.com/articles/63969-anterior-fontanelle-dermoid-cyst-surgical-technique\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Adeloye–Odeku disease, Anterior fontanelle, Inclusion cyst, Dermoid cyst","lastPublishedDoi":"10.21203/rs.3.rs-8473393/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8473393/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eAdeloye–Odeku disease, also known as anterior fontanelle inclusion cyst, is a rare congenital lesion commonly misdiagnosed as encephalocele. We present the first documented case in Ghana.\u003c/p\u003e\n\u003cp\u003eCase presentation\u003c/p\u003e\n\u003cp\u003eWe present an 8-month-old female with a painless, progressively enlarging scalp swelling over the anterior fontanelle since birth. Examination revealed cystic swelling with no cough impulse that transilluminates with light. A computed tomography (CT) scan and Magnetic Resonance Imaging (MRI) of the head revealed a well-defined, extradural located cystic mass without intracranial extension. Surgical excision was performed successfully, and histopathology confirmed a dermoid cyst.\u003c/p\u003e\n\u003cp\u003eConclusion\u003c/p\u003e\n\u003cp\u003eAdeloye–Odeku disease has been reported globally. It is commonly misdiagnosed as encephalocele. Diagnosis can be achieved with non-invasive imaging techniques, and total surgical excision is curative with great prognosis.\u003c/p\u003e","manuscriptTitle":"Adeloye–Odeku Disease: A Rare Anterior Fontanelle Inclusion Cyst in a Ghanaian Infant – Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-10 16:10:01","doi":"10.21203/rs.3.rs-8473393/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"198152813163777590839866550486269651484","date":"2026-02-11T15:05:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-10T21:04:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"190849470712665186991147111152854477226","date":"2026-02-08T05:07:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331640992326930407354887979277637092312","date":"2026-02-07T22:49:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"159905454104516210910246104629217426868","date":"2026-02-07T18:57:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-05T18:53:10+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-23T10:03:11+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-08T11:53:22+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-06T20:07:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2026-01-06T20:02:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a5b1c2ba-4ea9-4f76-8a67-5337eb159188","owner":[],"postedDate":"February 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-10T16:10:02+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-10 16:10:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8473393","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8473393","identity":"rs-8473393","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}