Prevention of growing skull fractures: report of 2 cases

J Neurosurg Pediatr. 2010 Feb;5(2):213-8. doi: 10.3171/2009.9.PEDS09180.

Abstract

The author describes 2 cases of children with growing skull fractures (GSFs). Surgical exploration of the widened fracture shortly after the head injury failed to reveal a dural tear because the neuroimaging studies (MR images, CT scans, and skull radiographs) had not been accurately interpreted, thereby allowing the development of a GSF at the site of the actual dural injury. In both cases, the dural and bony defect and the leptomeningeal cyst were successfully repaired. To prevent GSFs associated with progressive neurological deficit, seizure, ventricular porencephaly, and encephalomalacia, the author surgically explores wide skull fractures in young children with head injury whose MR images demonstrate brain herniation through the dura mater. The importance of a brief delay in surgical exploration is emphasized to allow cerebral edema to resolve and the patient's condition to become medically stabilized.

Publication types

  • Case Reports

MeSH terms

  • Accidental Falls
  • Accidents, Traffic
  • Brain Edema / etiology
  • Brain Edema / surgery
  • Cerebral Cortex / injuries
  • Cerebral Cortex / surgery
  • Craniocerebral Trauma / complications
  • Craniocerebral Trauma / surgery
  • Diagnostic Errors
  • Dura Mater / injuries
  • Encephalocele / etiology
  • Encephalocele / surgery
  • Humans
  • Infant
  • Magnetic Resonance Imaging
  • Male
  • Nervous System Diseases / etiology
  • Neurosurgical Procedures
  • Skull Fractures / diagnosis*
  • Skull Fractures / pathology*
  • Skull Fractures / surgery
  • Tomography, X-Ray Computed