Surgical results of growing skull fractures in children: a single centre study of 43 cases

Abstract

Being the second largest series to date, it adds significant valuable contribution to this topic. Poor prognostic factors were age >8 years, females, large defects (>7 cm), severe head injury at initial trauma, defects crossing midline and delayed repair (>8 months). Delayed onset seizures and new onset/progression of pre-existing deficits can be indirect markers of evolution. Surgical repair with water-tight dural closure is the standard treatment. Emphasis on early treatment is highlighted which is probably beneficial in improving neurological deficits. Good-to-excellent outcomes are noted in majority, even in cases with delayed presentations.

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

“…When children below the age of 3 years sustain skull fractures, diastatic enlargement of the fracture line can occur as growth proceeds, resulting in a growing skull fracture (GSF) [1][2][3] . Its incidence has been estimated as 0.05-1% of all pediatric skull fractures [2,[4][5][6][7] .…”

“…Cranial imaging using computed tomography (CT) or magnetic resonance imaging (MRI) is usually confirmatory and reveals underlying parenchymal changes as well [2,4,7,12] . 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] . 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] . Delay in intervention in case of GSF can result in seizures and focal neurological deficits [2][3][4][5] .…”

“…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] .…”