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Child's Nervous System

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01-06-2016 | Original Paper

Growing skull fractures: guidelines for early diagnosis and surgical management

Authors: Ishwar Singh, Seema Rohilla, Saquib Azad Siddiqui, Prashant Kumar

Published in: Child's Nervous System | Issue 6/2016

Abstract

Background

Growing skull fracture (GSF) is a rare complication of pediatric head trauma and causes delayed onset neurological deficits and cranial defect. GSF usually develops following linear fracture with underlying dural tear resulting in herniation of the brain. Early diagnosis and treatment are essential to avoid complications. However, there are no clear-cut guidelines for the early diagnosis of GSF. The present study was conducted to identify the criteria for the early diagnosis of GSF.

Material and methods

From 2010 to 2015, all pediatric patients of head trauma with linear fracture were evaluated. Patients of age <5 years with cephalhematoma, bone diastasis of 4 mm or more with underlying brain contusion were subjected to contrast brain MRI to find out the dural tear and herniation of the brain matter. Patients with contrast MRI showing dural tear and herniation of the brain matter were considered high risk for the development of GSF and treated surgically within 1 month of trauma. Patients with contrast brain MRI not showing dural tear and herniation of the brain matter were regularly followed for any signs of GSF.

Results

A total of 20 patients were evaluated, out of which 16 showed dural defects with herniation of the brain matter and were subjected to duraplasty. Four patients in which MRI did not show dural tear and herniation of the brain matter were regularly followed-up and have not shown any sign of GSF later on follow-up.

Conclusion

Early diagnosis of GSF can be made based on the four criteria, i.e., (1) age <5 year with cephalhematoma, (2) bone diastasis 4 mm or more (3) underlying brain contusion (4) contrast MRI showing dural tear and herniation of the brain matter. Dural tear with herniation of the brain matter is the main etiopathogenic factor for the development of GSF. Early diagnosis and treatment of GSF can yield a good outcome.

Ersahin Y, Gülmen V, Palali I, Mutluer S (2000) Growing skull fractures (craniocerebral erosion). Neurosurg Rev 23:139–144CrossRefPubMed

Ramamurthi B, Kalyanaraman S (1970) Rationale for surgery in growing fractures of the skull. J Neurosurg 32:427–430CrossRefPubMed

Taveras JM, Ransohoff J (1953) Leptomeningeal cysts of the brain following trauma with erosion of the skull; a study of seven cases treated by surgery. J Neurosurg 10:233–224CrossRefPubMed

Sharma RR, Chandy MJ (1991) Shunt surgery in growing skull fracture: a report of two cases. Br J Neurosurg 5:93–98

Djientcheu VDP, Njamnshi AK, Ongolo-Zogo P, et al. (2006) Growing skull fractures. Childs Nerv Syst 22:721–725CrossRef

Wang X, Li G, Li Q, You C (2013) Early diagnosis and treatment of growing skull fracture. Neurol India 61:497–500CrossRefPubMed

Tandon PN, Banerji AK, Bhatia R, Goulatia RK (1987) Cranio-cerebral erosion (growing fracture of the skull in children) part II. Clinical and radiological observations. Acta Neurochir(Wien) 88:1–9.

Lende RA, Erickson TC (1961) Growing skull fractures of childhood. J Neurosurg 18:479–489CrossRefPubMed

Prasad LG, Gupta DK, Mahapatra AK, Borkar SA, Sharma BS (2014) Surgical results of growing skull fractures in children: a single centre study of 43 cases. Childs Nerv Syst 31:25–29

10.

de Paul DV, Rilliet B, Delavelle J, Argyropoulo M, Gudinchet F, de Tribolet N (1996) Leptomeningeal cyst in newborns due to vacuum extraction: report of two cases. Childs Nerv Syst 12:399–403CrossRef

11.

Hayashi Y, Yamaki T, Odake G, Hashimoto Y, Ueda S (1997) Long term follow up of a growing skull fracture treated by dura and cranioplasty with artificial dura mater and methylmethacrylate. Childs Nerv Syst 13:349–351CrossRefPubMed

12.

Roy S, Sarkar C, Tandon PN, Banerji AK (1987) Cranio-cerebral erosion (growing fracture of the skull in children)Part I Pathology. Acta Neurochir (Wien) 87:112–118CrossRef

13.

Zegers B, Jira P, Willemsen M, Grotenhuis J (2003) The growing skull fracture, a rare complication of paediatric head injury. Eur J Pediatr 162:556–557CrossRefPubMed

14.

Ziyal IM, Aydin Y, Türkmen CS, Salas E, Kaya AR, Ozveren F (1998) The natural history of late diagnosed or untreated growing skull fractures: report on two cases. Acta Neurochir 140:651–654CrossRefPubMed

15.

Gupta SK, Reddy NM, Khosla VK, et al. (1997) Growing skull fractures: a clinical study of 41 patients. Acta Neurochir 139:928–932CrossRefPubMed

16.

Kingsley D, Till K, Hoare R (1978) Growing fractures of the skull. J Neurol Neurosurg Psychiatry 41:312–318CrossRefPubMedPubMedCentral

17.

Lenthal R, Penney C (1999) Growing skull fracture extending posteriorly to the superior sagittal sinus with intradiploic extension. Br J Radiol 72:714–716CrossRef

18.

Menku A, Kemal Koc R, Tucer B, Kurtsoy A, Akdemir H (2004) Growing skull fracture of the orbital roof. Neurosurg Rev 27:133–136CrossRefPubMed

19.

Howship J (1816) Practical observations in surgery, and morbid anatomy. A. Strahan, London

20.

Arseni C, Ciurea AV (1981) Clinicotherapeutic aspects in the growing skull fracture. A review of the literature. Childs Brain 8:161–172PubMed

21.

Muhonen MG, Piper JG, Menezes AH (1995) Pathogenesis and treatment of growing skull fractures. Surg Neurol 43:367–373CrossRefPubMed

22.

Tandon PN, Banerji AK, Bhatia R, Goulatia RK (1987) Cranio-cerebral erosion (growing fracture of the skull in children). Part II. Clinical and radiological observations. Acta Neurochir (Wien) 88:1–9

23.

Liu XS, You C, Lu M, Liu JG (2012) Growing skull fracture stages and treatment strategy. J Neurosurg Pediatr 9:670–675CrossRefPubMed

24.

Goldstein F, Sakoda T, Kepes JJ, Kavidson K, Brackett CE (1967) Enlarging skull fractures: an experimental study. J Neurosurg 27:541–550CrossRefPubMed

25.

Goldstein FP, Rosenthal SA, Garancis JC, Larson SJ, Brackett CE Jr (1970) Varieties of growing skull fractures in childhood. J Neurosurg 33:25–28CrossRefPubMed

26.

Ito H, Miwa T, Onodra Y (1977) Growing skull fracture of childhood with reference to the importance of the brain injury and its pathogenetic consideration. Childs Brain 3:116–126PubMed

27.

Scarfò GB, Mariottini A, Tomaccini D, Palma L (1989) Growing skull fractures: progressive evolution of brain damage and effectiveness of surgical treatment. Childs Nerv Syst 5:163–167CrossRefPubMed

28.

Reddy DR (2013) Growing skull fractures: guidelines for early diagnosis and effective operative management. Neurol India 61:455–456CrossRefPubMed

29.

Gugliantini P, Caione P, Fariello G, Rivosecchi M (1980) Post traumatic leptomeningeal cysts in infancy. Pediatr Radiol 9:11–14CrossRefPubMed

30.

Simon B, Letourneau P, Vitorino E, McCall J (2001) Pediatric minor head trauma: indications for computed tomographic scanning revisited. J Trauma 51:231–238CrossRefPubMed

31.

Ergün R, Okten AI, Akdemir G, Beskonakli E, Gürsoy F, Taskin Y (1998) Cranio-cerebral erosion: delayed diagnosis and treatment. Neurosurg Rev 21:249–253CrossRefPubMed

32.

Kutlay M, Demircan N, Akin ON, Basekim C (1998) Untreated growing cranial fractures detected in late stage. Neurosurg 43:72–77CrossRef

33.

Vignes JR, Jeelani NU, Jeelani A, Dautheribes M, Liguoro D (2007) Growing skull fracture after minor closed-head injury. J Pediatr 151:316–318CrossRefPubMed

34.

Voet D, Govaert P, Caemaert J, de Lille L, D’herde K, Afschrift M (1992) Leptomeningeal cyst: early diagnosis by color Doppler imaging. Pediatr Radiol 22:417–418CrossRefPubMed

35.

Diyora B, Nayak N, Kamble H, Kukreja S, Gupte G, Sharma A (2011) Surgical treatment and results in growing skull fracture. Neurol India 59:424–428CrossRefPubMed

36.

Matsuur H, Omama S, Yoshida Y, et al. (2012) Use of magnetic resonance imaging to identify the edge of a dural tear in an infant with growing skull fracture: a case study. Childs Nerv Syst 28:1891

37.

Crocker M, Tawari G, Robertson F, Connor S, Bassi S (2006) Growing skull fracture in the absence of a dural tear. Br J Neurosurg 20:97–99CrossRefPubMed

Title: Growing skull fractures: guidelines for early diagnosis and surgical management
Authors: Ishwar Singh
Seema Rohilla
Saquib Azad Siddiqui
Prashant Kumar
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 6/2016
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-016-3061-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Growing skull fractures: guidelines for early diagnosis and surgical management

Abstract

Background

Material and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Material and methods

Results

Conclusion

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