Growing skull fractures; pathogenesis and surgical outcome

Background: We performed a retrospective study of 67 patients and their data for radiological investigations by serial Xrays, computed tomography, magnetic resonance imaging, uniform surgical procedure of craniotomy. The results were analyzed to determine the natural course of the disease, anatomical changes at various intervals following trauma, and outcome of surgical procedure in terms of cranial reconstruction, seizures, and progress in neurological deficit. Results: Among 67 patients, 34 (50.74%) were male and 33 (49.26%) were female patients. About 86.67% of patients sustained the injury before the age of 3 years. Development of seizures in 28 patients (41.80%) is the most common symptom. In our study, 43.28% of patients (29 cases) had a combination of Type I and II of growing skull fracture. The dural defects confirmed in all cases were nearly twice (average 1.42) as large as the bone defects. All patients under the age of 3 years with diastatic skull fracture should be closely followed up and should be examined 2–3 months later to look for evidence of a growing skull fracture. Linear fractures and burst fractures in an infant with a scalp swelling must be corrected early to prevent a growing skull fracture. Conclusion: Early management can avoid difficult surgical dissection and progressive neurological sequelae seen with delayed intervention. Surgical correction results in the prevention of brain shift and increase in meningocerebral cicatrices. Meticulous surgery and vigilant postoperative care reduce the morbidity and mortality. In our opinion, the autologous material is the best choice because of its tissue compatibility, convenience, inexpensiveness, and rare rate of infection.

Key-words:

Duroplasty - growing skull fracture - linear skull fracture

Financial support and sponsorship

Nil.

Publication History

Received: 24 August 2018

Accepted: 26 January 2021

Article published online:
16 August 2022

• References

• 1 Djientcheu VD, Rilliet B, Delavelle J, Argyropoulo M, Gudinchet F, de Tribolet N. Leptomeningeal cyst in newborns due to vacuum extraction: Report of two cases. Childs Nerv Syst 1996;12:399-403.
• 2 Ersahin Y, Gulmen V, Palali I, Multer S. Growing skull fractures. Neurosurg Rev 2000;23:139-44.
• 3 Haar FL. Complication of linear skull fracture in young children. Am J Dis Child 1975;129:1197-200.
• 4 Gruber FH. Posttraumatic leptomeningeal cyst. Am J Radiol 1969;105:305-7.
• 5 Guilburd JN, Rakier A. Growing skull fracture: A clinical study in 15 children. Clin Neurol Neurosurg 1997;99;1:S259.
• 6 Gupta SK, Reddy NM, Khosla VK, Mathuriya SN, Shama BS, Pathak A, et al. Growing skull fractures: A clinical study of 41 patients. Acta Neurochir (Wien) 1997;139:928-32.
• 7 Halliday AL, Chapman PH, Heros RC. Leptomeningeal cyst resulting from adulthood trauma. Neurosurgery 1990;26:150-3.
• 8 Howship PJ. Practical Observations in Surgery and Morbid Anatomy. London: Longman; 1816. p. 494.
• 9 Kyoshima K, Gibo H, Kobayashi S, Sugita K. Cranioplasty with inner table of bone flap. Technical note. J Neurosurg 1985;62:607-9.
• 10 Lende R, Erickson TC. Cranial defects developing at fracture sites in children. Trans Am Neurol Assoc 1959;13:130-1.
• 11 Michael GM, John GP, Arnold HM. Pathogenesis and treatment of Growing Skull Fracture. Surg Neurol 1995;43:367-73.
• 12 Miranda P, Vila M, Alvarez-Garijo JA, Perez-Nunez A. Birth trauma and development of growing fracture after coronal suture disruption. Childs Nerv Syst 2007;23:355-8.
• 13 Numerow LM, Krcek JP, Wallace CJ, Tranmer BI, Auer RN, Fong TC: Growing skull fracture simulating a rounded lytic calvarial lesion. AJNR 1991;12:783-4.
• 14 Palaoglu S, Beskonakli E, Senel K, Taskin Y, Yaleinlar Y. Intraosseus location of posterior fossa posttraumatic leptomeningeal cyst. Neuroradiology 1990;32:78.
• 15 Pezzotta S, Silvani V, Gaetani P, Spanu G, Rondini G. Growing skull fractures of childhood. Case report and review of 132 cases. J Neurosurg Sci 1985;29:129-35.
• 16 Rahimizadeh A. Growing fracture of the skull in the elderly. Neurosurgery 1986;19:675-6.
• 17 Rahman Nain VR, Abedeen B, Tanjoom ZA, Tanjoom HB, Murshid WR. Growing skull fractures. Classification and management. Br J Neurosurg 1994;8:667-9.
• 18 Ramamurthi B, Kalyanaraman S. Rationale for surgery in growing fractures of the skull. J Neurosurg 1970;32:427-30.
• 19 Ruberti RF. Cranioplasty with inner table of bone flap in children: Report of two cases. Afri J Neur Sci 1997;16:2.
• 20 Sharma A. Bindra GS, Kaur R. Why some skull fractures in children grow: Observations on pathogenesis of growing fracture of skull. Journal of Pediatric Neurosciences 2011;13:129-35.
• 21 Sharma A, Tatke M, Abraham M. Diastatic fracture of the skull with pseudomeningocele in childhood. Clin Neurol Neurosurg 1997;99:S259.
• 22 Smith T. Traumatic cephalhydrocelc. St bartholomew's hospital reports 1884;20:033-240.
• 23 Tandon PN, Banerji AK, Bhatia R, Goulatia RK. Cranio-cerebral erosion (growing fracture of the skull in children). Part II: Clinical and radiological observations. Acta Neurochir (Wien) 1987;88:1-9.
• 24 Taveras J, Ransohoff S. Leptomeningeal cysts of the brain following trauma with erosion of the skull: A study of seven cases treated by surgery. J Neurosurg 1953;10:233-41.
• 25 Thompson JB, Mason TH, Haines GL, Cassidy RJ. Surgical management of diastatic linear skull fractures in infants. J Neurosurg 1973;39:493-7.
• 26 Scarfo GB, Mariottini A, Tomoccini D, Palma L. Growing skull fractures: Progressive evolution of brain damage and effectiveness of surgical treatment. Childs Nerv Syst 1989;5:163-7.
• 27 Zegers B, Jira P, Willemsen M, Grotenhuis J. The growing skull fracture, a rare complication of paediatric head injury. Eur J Pediatr 2003;162:556-7.
• 28 Ziyal IM, Aydin Y, Türkmen CS, Salas E, Kaya AR, Ozveren F. The natural history of late diagnosed or untreated growing skull fractures: Report on two cases. Acta Neurochir (Wien) 1998;140:651-4.