Craniocerebral birth trauma caused by vacuum extraction: a case of growing skull fracture as a perinatal complication

Abstract

A case of growing skull fracture following birth trauma and caused by vacuum extraction is reported in order to emphasize the incidence of this peculiar head injury at the beginning of extrauterine life and to point out its relation to possible neuropsychological disturbances that may appear later in childhood. Delivery by vacuum extraction increases the incidence of perinatal injuries and consequently the incidence of neurological deficits in children. Neurosurgical repair is advocated as the appropriate treatment, with the aim not only of cosmetically correcting the lesion's typical subgaleal protuberance with cranioplasty, but also of performing a water-tight closure of the dura, enabling the cerebral cortex to "fill in" the intracerebral lesion. The surgical technique and gross pathology of the lesion are described together with radiological findings before and after surgery. Reports by other authors are reviewed in an attempt to identify the conditioning factors and pathological features of this traumatic injury to skull and brain in neonates and infants. The literature on cranial fractures associated with intracerebral lesions at this age shows a significant difference in recovery and outcome from that after similar lesions in older children.

Growing skull fractures (craniocerebral erosion)

“…Dilatation of the ipsilateral ventricle was also detected in most cases [3,4,7,13,26,27,30,37,38,41,48]. Porencephalic cysts in communication with the lateral ventricle have been reported in some [4,13,23,30,37,38]. On MRI, Mohunen et al [7] detected patterns in tissue herniation through the skull defect: (1) solely brain herniating through the fracture, (2) leptomeningeal cyst and brain parenchymal herniation, and (3) leptomeningeal cyst herniation.…”

“…Falling appears to be the most frequent cause of injury. Motor vehicle accidents, child abuse, birth injuries, and previous cranial surgery can also lead to GSF [4,7,13,25,[34][35][36][37][38][39][40][41][42]. Moss et al [43] even reported intrauterine GSF.…”

Fratura evolutiva de crânio na infância – Relato de cinco casos e revisão de literatura

“…30 Nos 11 pacientes com FEC descritos por Diyora et al, 37 duas crianças apresentavam FEC tipo I; sete crianças classificavam-se como tipo II e duas apresentavam FEC tipo III. Existem relatos em alguns trabalhos na literatura de comunicação entre o cisto porencefálico com o ventrículo lateral, 27,34,51,55 bem como dilatação do ventrículo ipsilateral à FEC. 19,34,40,49 A RMN é útil no diagnóstico da FEC, porque claramente identifica lesões associadas, por exemplo, cistos, relação da fratura com os seios venosos ou conhecimento do volume de tecido cerebral herniado pelo defeito ósseo.…”

Birth Injury of the Cranium and Central Nervous System

“…CH may be associated with a skull fracture; and leptomeningeal cysts may occur along the fracture line, but usually regress and only infrequently require surgical treatment (1, 5). Diastatic fractures (fractures along suture lines) have been described with instrument‐assisted deliveries and may result in “growing fractures,” which are fractures that expand with time (17, 26, 31). Calcification of birth‐associated fractures is visible on radiographs by 7 days of life.…”