Growing skull fracture stages and treatment strategy

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>A growing skull fracture (GSF) is a rare but significant late complication of skull fractures, usually occurring during infancy and early childhood. Delayed diagnosis and improper treatment could exacerbate this disease. The aim of this study was to introduce a new hypothesis about, describe the stages of, and discuss the treatment strategy for GSF.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors performed a retrospective review of 27 patients with GSF, who were grouped according to 3 different GSF stages.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Over a period of 20 years, 27 patients with GSF (16 males and 11 females) were treated in the authors' department. The mean follow-up period was 26.5 months. Six patients were in the prephase of GSF (Stage 1), 10 patients in the early phase (Stage 2), and 11 in the late phase (Stage 3). All patients underwent duraplasty. All 6 patients at Stage 1 and 5 patients at Stage 2 underwent craniotomy without cranioplasty. Five patients at Stage 2 and all of the patients at Stage 3 underwent cranioplasty with autologous bone and alloplastic materials, respectively. Among all patients, 5 underwent ventriculoperitoneal shunt placement.</jats:p> <jats:p>Symptoms in all patients at Stages 1 and 2 were alleviated or disappeared, and the cranial bones developed without deformity during follow-up. Among patients with Stage 3 GSF, no obvious improvement in neurological deficits was observed. Three patients underwent additional operations because of cranial deformation or infection.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The authors identify the stages of GSF according to a new hypothesis. They conclude that accurately diagnosing and treating GSF during Stages 1 and 2 leads to a better prognosis.</jats:p></jats:sec>

Post-Traumatic Leptomeningeal Cyst in Child: A Case Report and Review of Literature

“…Prompt diagnosis is essential as early corrective surgery should be performed for growing skull fractures so as to prevent secondary brain damage and neurological deficits which especially occur in late stages and lead to progressive disruption in the quality of life of patients (Liu X, 2012). A clinical, radiological, and histopathological correlation helps in diagnosing types of growing skull fracture and thereby to assess its prognosis.…”

Growing Skull Fracture and the Orbitocranial Variant: Nuances of Surgical Management

“…GSF has been estimated to occur in less than 1% of all pediatric skull fractures, with trauma being the cause in almost all cases [2,[4][5][6][7] . Occurrence of GSF following craniosynostosis repair has been reported [17,18] .…”

“…Early surgical intervention is considered to yield good cosmetic results, irrespective of the location of the lesion [2,7,13] . Delay in intervention in case of GSF can result in seizures and focal neurological deficits [2][3][4][5] . An additional area of interest, which has been sparingly addressed, is the management of an orbitocranial variant of GSF.…”

“…As per current understanding, surgery is recommended in all cases and involves dural repair with or without cranioplasty [2,4,5,7] . Early surgical intervention is considered to yield good cosmetic results, irrespective of the location of the lesion [2,7,13] .…”

“…Its incidence has been estimated as 0.05-1% of all pediatric skull fractures [2,[4][5][6][7] . GSF is thought to result from a dural tear through which the leptomeninges and the brain parenchyma herniate, forming a cystic sac which manifests as a soft, progressive, nontender swelling at the site of the original fracture [8][9][10] .…”