Growing skull fractures are rare complications of head injury, occurring almost exclusively in infants and children under the age of three. A retrospective review at our Institute yielded 41 patients with this entity over a period of 20 years (1975-1995). The age at presentation ranged from less than 1 year to 62 years, with 33 (80.5%) patients being less than 5 years of age. The cause of injury was either a fall from a height (93%) or a road traffic accident. The most common location of a growing skull fracture was either parietal or frontoparietal (56%). One patient had a posterior fossa growing skull fracture. CT scan was performed in 19 patients which demonstrated an underlying porencephalic cyst, hydrocephalus or a cyst communicating with the ventricle. In 5 children, a ventriculo-peritoneal shunt alone was performed. Twenty four patients underwent a duro- and cranioplasty while a duroplasty alone was performed in 8 patients. The material used for cranioplasty included acrylic, wire mesh, steel plates or autologous bone. Three patients died, one due to an anaesthetic complication and two as a result of postoperative meningitis. Post-operative CSF leaks occurred in 3 patients, which were managed by a lumbar drain. Six patients had local wound infection.

Non-missile penetrating injuries of the spine accounted for 7% of all spinal injuries admitted to this Institute during the last 10 years. Young males were most commonly affected and 73% of the injuries involved the upper dorsal und cervical spine. They presented with varying degrees of neurological deficit. Plains x-rays revealed the bony injury and/or the retained foreign body satisfactorily. Myelography (with or without CT scan) was performed in patients with progressive neurological deterioration and those not responding to conservative therapy. Surgery remained the mainstay of treatment and improved neurological function in 7 out of 9 cases. Conservative management resulted in complications such as persistent CSF fistula, uncontrolled fulminant meningitis and septicaemia, with 100% mortality. Early surgical intervention is, therefore, recommended in all penetrating injuries of the spine.

No abstract

The normal configuration of the arterial pattern at the base of the brain in rhesus monkeys, dogs, sheep, goats and rabbits is described. The length and diameter of all vessels of the circulus arteriosus cerebri are measured. Variations are compared in relation to that of the typical pattern present in humans. In rhesus monkeys, dogs and rabbits, the circle of Willis is almost similar to that in human beings except that in these animals, (i) the anterior cerebral arteries join each other to form a single median vessel; (ii) in dogs, rabbits, goats and sheep the anterior cerebellar artery is a branch of posterior cerebral artery, and (iii) in goats and sheep, a considerable length of the internal carotid artery contributes to the formation of circulus arteriosus while the posterior cerebral artery arises from the posterior communicating artery.

A high index of suspicion and awareness of this condition may lead to more cases being diagnosed early. Surgery may be avoided in selected cases that can be treated primarily with antitubercular therapy.