Growing fractures of the skull.

Growing fractures rarely arise in the skull base. Only six cases of orbital roof growing fractures were found in the relevant literature. We report two such cases. The first case was a 2-year-old girl who had progressive proptosis for 6 months following a mild head injury 1 year previously. The second case was a 9-year-old girl with a history of injury at the age of 3 months. She developed eye deviation and proptosis for 1 year. Computed tomography scan is excellent for demonstrating bony defects in the orbital roof, while magnetic resonance imaging is more sensitive in showing the intraorbital extension of a leptomeningeal cyst. Both patients were operated successfully and proptosis disappeared postoperatively. The exact pathophysiology of growing fractures is still debated in the literature, but a dural laceration along a fracture line is noted in all cases, and frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing fractures of the orbital roof should be suspected if ocular symptoms appear in a child who had sustained a head injury several months or years before.

Section: Introductionmentioning

confidence: 99%

Growing Fractures of the Orbital Roof

Suri

Mahapatra

2002

“…Characteristic features of this entity include a skull fracture with an underlying dural tear and progressive enlargement of the fracture with time to produce a cranial defect [1, 4, 5, 6]. The incidence of growing skull fractures is only 0.6% of the cases in large series [2, 3].…”

Section: Introductionmentioning

confidence: 99%

Growing Skull Fracture of the Orbital Roof

Koç¹,

Kurtsoy²,

Oktem³

et al. 1999

Growing skull fractures are rare complications of head trauma and very rarely arise in the skull base. The clinical and radiological finding and treatment of a growing fracture of the orbital roof in a 5-year-old boy are reported, and the relevant literature is reviewed. The clinical picture was eyelid swelling. Computed tomography (CT) scan was excellent for demonstrating the bony defect in the orbital roof. Frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing skull fracture of the orbital roof should be considered in the differential diagnosis in cases of persistent ocular symptoms. Craniotomy with excision of gliotic brain and granulation tissue, dural repair and cranioplasty is the treatment of choice.

“…GSFs, a complication of head injuries in children under 3 years of age, typically require a bony defect, an underlying durotomy and the dura to be under tension (as is the case with a rapidly developing brain) to occur [2,3,4,5,6]. Two of the three elements necessary for the development of GSFs, a cranial vault defect and a rapidly expanding process in the brain, are present in infants undergoing craniofacial surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Ultimately, this defect enlarges and the brain parenchyma may ultimately herniate into the subgaleal space. This process can take anywhere between weeks and years to develop [3,26]. If left untreated, eventual neurologic complications such as seizures and hemiparesis may occur [27].…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, and primarily in children under 3 years of age [2], so-called growing skull fractures (GSFs) or leptomeningeal cysts may develop. The factors thought to be necessary for this to occur are a cranial bone defect, an underlying dural tear and an expanding intracranial process such as rapid brain growth resulting from normal neurodevelopment [2,3,4,5,6]. In children with a GSF, there is progressive widening of the fracture, herniation of the leptomeninges and, ultimately, if left untreated, herniation of the underlying brain parenchyma.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Risk of Growing Skull Fractures in Craniofacial Patients

Keshavarzi¹,

Meltzer²,

Cohen³

et al. 2010

Background/Aims: Growing skull fractures (GSFs) are unusual sequelae of head injury in young children which have also been reported to occur after craniofacial procedures complicated by inadvertent durotomy. We reviewed the craniofacial experience in a single institution, detailing 180 cases of craniofacial surgery and suspected dural tears and their relationship to the subsequent development of GSFs. This experience was then compared to that of the pertinent published literature. Methods: A retrospective review of the senior authors’ craniofacial surgical experience from 2000 to 2007 was performed. This was compared to an English-language literature review of GSFs after craniofacial surgery. Results: In our institution, 180 cases of craniofacial surgery (83 open, 97 endoscopic) were performed, with an average follow-up of 23.5 months. Twenty-five patients (15 open, 10 endoscopic surgeries) had operative dural compromise. One of these patients developed a persistent pseudomeningocele requiring reoperation. Twelve cases of GSF after craniofacial surgery were identified in a review of the English-language literature, of which 7 (58%) had coronal suture fusion. Conclusions: While durotomy may occur during craniofacial surgery, the subsequent development of a GSF appears to be an unlikely event with an aggressive intraoperative approach of identification and repair. Coronal craniosynostosis may confer an increased risk for this complication.