Growing skull fractures (craniocerebral erosion)

Abstract

The incidence of growing skull fractures ranges from less than 0.05% to 1.6%. We reviewed 22 growing skull fracture patients retrospectively. There were 15 boys and seven girls ranging in age from newborn to 6 years (mean: 12.4 months) at the time of injury. Falling was the most frequent cause of injury. In total, 17 patients presented with a scalp mass. The scalp was sunken over the bone defect in three patients. Other symptoms and signs were seizure in five patients, hemiparesis in four, recurrent meningitis in one, and pulsatile exophthalmus in one. The most common location was the parietal region. The extent of dural defect was always greater than that of bony defect, except in one case that had been previously shunted for hydrocephalus. In another patient with a growing fracture in the posterior cranial fossa, the dural edges could not be exposed, although a wide craniotomy was performed. Therefore, a cystoperitoneal shunt was inserted. Gliotic tissue was present in all the patients. Cyst or cystic lesions were observed in only nine patients, duraplasty was performed in 21, 16 were neurologically intact, and six had minor deficits. All patients under the age of 3 years with a diastatic skull fracture should be closely followed up. A sustaining diastatic fracture and brain herniation through the skull defect shown on CT or MRI imply a growing skull fracture.

A Case of Growing Skull Fracture with Appearance of the Sinking Skin Flap Syndrome

“…The dura adheres more tightly to bone during infancy and early childhood, and hence it is more easily torn in infants and children when a fracture occurs. 2 The arachnoid bulges through the dural defect by the pulsation of cerebrospinal fluid (CSF), and cyst formation is postulated to take place thereafter. [7][8][9] Crocker at al.…”

“…2 However, headache is a common presentation of untreated GSFs in late stages. 14 The plain X-ray reveals an irregular oval or elliptical skull defect.…”

“…The incidence of GSF ranges from 0.05 to 1.6% of pediatric skull fractures, and the patients generally present with scalp swelling and neurological deficits. 2,3 It is known that the scalp overlying the defect can appear flat or sunken. 2,4 However, orthostatic sinking of the scalp over the GSF has not been reported.…”

“…2,3 It is known that the scalp overlying the defect can appear flat or sunken. 2,4 However, orthostatic sinking of the scalp over the GSF has not been reported.…”

Variation in the use of skull radiographs by emergency physicians in young children with minor head trauma

“…10,[12][13][14] The importance of detecting isolated skull fracture arises from the fact that depressed fractures or those with large diastasis require neurosurgical evaluation and, in some cases, surgical intervention. [15][16][17][18] Controversy exists on the usefulness of skull radiographs in children less than 2 years of age with minor head trauma. Although cerebral computed tomography (CT) has become the imaging modality of choice to evaluate an intracranial injury in the ED setting, it is clear that not all young children with minor head trauma require a CT scan.…”