GROWING SKULL FRACTURE – CASE REPORT AND REVIEW OF THE LITERATURE
Abstract
Background. Growing skull fracture is a progressive enlargement of a fracture. It produces a cranial defect. It is a rare complication of head injury, occurring almost exclusively in infants and children under the age of three. It rarely occurs latter than 6 months from the injury. This condition requires both a widely separated fracture and a dural tear. Most growing skull fractures are brought to medical attention when the palpable mass is noticed. If left untreated it might lead to neurological deficit and/or epilepsy. MR combined with CT scan and plain skull X-rays is and indispensable procedure for diagnosis of growing skull fracture. Treatment is surgical with dural closure mandatory.
Patient and methods. A 10-month-old male infant felt down stairs and suffered a blow in his right parietal region. On admission, he was conscious with Children Coma Scale Score (CCS) 11. He had no neurological deficits. Skull X-ray just after the injury showed a diastatic right parietal skull fracture about 5 mm in diameter spreading from lambdoid toward the sagittal suture. CT scan upon admission revealed the above mentioned fracture line but no brain contusion. Ten days later, he was discharged home. Repeated skull films revealed growth of a fracture line. 3D CT demonstrated a growing skull fracture. MR revealed cortical atrophy, cystic lesion beneath the bone defect and subgaleal cerebral herniation. He was operated 7 months after injury. A dural reconstruction with the periost graft and a cranioplasty with titanium mesh were performed. The postoperative course was uneventful except one seizure. After 2 weeks, he was discharged with no neurological deficit.
Conclusions. This entity consists of a skull fracture with an underlying dural tear those courses with a progressive enlargement of the fracture to produce a cranial defect. Physiologic growth of the brain contributes to the fracture enlargement. This complication must be recognized early in order to obtain good results after surgical therapy.
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References
Ramamurthi B, Kalyanaraman S. Rationale for surgery in growing fracture of the skull. J Neurosurg 1970; 32: 427–30.
Greenberg MS. Handbook of neurosurgery. 4th ed. Lakeland, Florida: Greenberg Graphics, 1997: 726–6.
Murshid WR. Management of minor head injuries: admission criteria, radiological evaluation and treatment of complications. Acta Neurochir 1998; 140: 56–64.
Gadoth N, Grunebaum M, Young L. Leptomeningeal cyst after skull fracture. Am J Ds Child 1983; 137: 1019–20.
Britz GW, Kim DK, Mayberg MR. Traumatic leptomeningeal cyst in an adult: a case report and review of the literature. Surg Neurol 1998; 50: 465–9.
Halliday AL, Chapman PH, Heros RC. Leptomeningeal cyst resulting from adulthood trauma: case report. Neurosurgery 1990; 26: 150–3.
Iplikcglu AC, Kokes F, Bayar A et al. Leptomeningeal cyst. Neurosurgery 1990; 27: 1027–8.
Gupta SK, Reddy NM, Khosla VK et al. Growing skull fractures: a clinical study of 41 patients. Acta Neurochir 1997; 139: 928–32.
Muhonen MG, Piper JG, Menezes AH. Pathogenesis and treatment of growing skull fractures. Surg Neurol 1995; 43: 367–72.
Sekhar LN, Scarff TB. Pseudogrowth in skull fractures of childhood. Neurosurgery 1980; 6: 285–9.
Mierez R, Guillen A, Brell M, Cardona E, Claramunt E. Growing skull fracture in childhood. Presentation of 12 cases. Neurochirurgia 2003; 14: 228–33.
Husson B, Pariente D, Tammam S, Zerah M. The value of MRI in the early diagnosis of growing fracture. Pediatr Radiol 1996; 26: 744–7.
Ishibashi H, Matsuno H, Yamashita Y et al. Growing skull fracture: a case report. No Shinkei Geka 1995; 23: 741–4.
Wang J, Bartkowski HM. Early onset of leptomeningeal cyst with severe brain herniation: report of two cases. Neuropediatrics 1997; 28: 184–8.
Ito H, Miwa T, Onodra Y. Growing skull fracture of childhood with reference to the importance of the brain injury and its pathogenetic consideration. Childs Brain 1977; 3: 116–26.
Tsuzuki N, Suzuki K, Matsuno A, Hasizume K. A growing skull fracture: a case report. No Shinkei Geka 1993; 21: 641–4.
Kuwata T, Kamei I, Uematsu Y, Iwamoto M, Kuriyama T. Growing skull fracture with rapid growth: a case report. No Shinkei Geka 1988; 16: 677–81.
Naim-Ur-Rahman, Jamjoom Z, Jamjoom A, Murshid WR. Growing skull fractures: classification and management. Br J Neurosurg 1994; 8: 667–79.
Yamamoto Y, Kunishio K, Sunami N. Enlarging skull fracture treated by early surgery. Case report. Neurol Med Chir 1989; 29: 137–41.
Gopal Iyer S, Saxena P, Kumhard GD. Growing skull fractures. Indian Pediatr 2003; 40: 1194–6.
Sato O, Tsugane R, Kageyama N. Growing skull fractures of childhood. Possible mechanism of its focal ventricular dilatation. Childs Brain 1975; 1: 148–57.
Kutlay M, Demircan N, Akin ON, Basekim C. Untreated growing cranial fractures detected in later stage. Neurosurgery 1998; 43: 72–6.
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