Growing Skull Fracture

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aka posttraumatic leptomeningeal cysts

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Contents

Definition

  • A fracture line that widens with time because of an underlining dural laceration and progressive herniation of the brain

Clinical findings

  • Uncommon; 0.05-.1% of skull fractures of children
  • Mean age of 1 yo, almost exclusively in children below 3 yo
  • A soft progressive pulsatile scalp mass with or without neurological deficit, seizure and rarely post traumatic aneurysm
  • Most common localization = parietal bone
  • Rarely occurs more than 6 months after a trauma

Pathophysiology

  • Often associated with a diastatic or long linear fracture
  • Due to a peri-injury tear in the dura with subsequent enlargement in the separation between the fracture fragments, possible erosion of the bone, and external cerebral herniation through the separated fractured elements. While pulsations of the brain may contribute, growth of the developing brain likley plays a major role as growing skull fractures are seen only in infants and very young children.

Imaging

  • X-Ray: Widening of fracture and scalloping of the edges

Treatment

  • Open fracture reduction with dural closure
  • Requires a craniotomy to close the dural defect with a dural graft

Follow-up

  • Children < 3 y.o. with a linear or diastatic skull fracture need a f/u skull film at 2 months post injury or close clinical follow-up with examination, including careful palpation, of the fracture site

References

  • Handbook of Neurosurgery, Mark S. Greenberg, THIEME, 7th Edition (2010), p.892
  • Principles and Practice of Pediatric Neurosurgery, A. Leland Albright, Ian F. Pollack, P. David Anderson, THIEME, 2nd Edition (2007), p.804
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