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.

Surgical results of growing skull fractures in children: a single centre study of 43 cases

“…Ours being a tertiary care trauma centre, delayed referral is a common phenomenon; this combined with parent and physicians' ignorance contributed to the late presentation of our patients. Ersahin et al [4] reported no recurrence with duraplasty alone in majority of their cases and similar results have been noted by other authors as well [3,2,15,7]. We performed duraplasty in four of our cases with smaller defects and achieved satisfactory results (Fig.…”

“…Also, brain grows rapidly in the first 2 years which widens the defect and thus they are more prone to GSF. Alternatively, in these children, the skull is thinner and deformable and dural tear occurs because of this deformation [3, 4,29,30]. In our study, we analysed only paediatric data and had 31 cases (72 %) of these lesions in children below 3 years of age which is comparable to other reports.…”

Surgical results of growing skull fractures in children: a single centre study of 43 cases

“…Ours being a tertiary care trauma centre, delayed referral is a common phenomenon; this combined with parent and physicians' ignorance contributed to the late presentation of our patients. Ersahin et al [4] reported no recurrence with duraplasty alone in majority of their cases and similar results have been noted by other authors as well [3,2,15,7]. We performed duraplasty in four of our cases with smaller defects and achieved satisfactory results (Fig.…”

“…Also, brain grows rapidly in the first 2 years which widens the defect and thus they are more prone to GSF. Alternatively, in these children, the skull is thinner and deformable and dural tear occurs because of this deformation [3, 4,29,30]. In our study, we analysed only paediatric data and had 31 cases (72 %) of these lesions in children below 3 years of age which is comparable to other reports.…”

Growing Skull Fracture of Temporal Bone in Adults: A Case Report and Literature Review

“…The increasing pressure on fracture edges created by brain pulsation and herniation of intracranial tissue would prevent them from apposition and healing. 5,6,8,11,12,19 In consistent with previous studies, 20,8 we don’t think the intracranial expansive force of CSF cyst can result in elevated intracranial pressure unless there was hydrocephalus (in our literatures review, such cases or speculation were not reported) because in the course of GSF, skull will accordingly enlarge. And surgical repairment of dura matter and cranium is the most widely applied treatment.…”

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

“…13 A GSF can be associated with a leptomeningeal cyst, encephalomalacia, cystic parenchymal lesions, porencephaly, unilateral ventricular dilatation, hydrocephalus, pseudomeningoencephalocele, intraventricular cyst and lytic bone lesion mimicking a skull tumor. 2,13,16,17 In addition, in this report orthostatic sinking of the scalp over the GSF such as SSFS is shown. The SSFS has been described as one of the causes of neurological deterioration after a large craniectomy during a neurosurgical procedure due to the compression of the skin flap onto the brain.…”

Surgical results of growing skull fractures in children: a single centre study of 43 cases

“…Ours being a tertiary care trauma centre, delayed referral is a common phenomenon; this combined with parent and physicians' ignorance contributed to the late presentation of our patients. Ersahin et al [4] reported no recurrence with duraplasty alone in majority of their cases and similar results have been noted by other authors as well [3,2,15,7]. We performed duraplasty in four of our cases with smaller defects and achieved satisfactory results (Fig.…”

“…Also, brain grows rapidly in the first 2 years which widens the defect and thus they are more prone to GSF. Alternatively, in these children, the skull is thinner and deformable and dural tear occurs because of this deformation [3, 4,29,30]. In our study, we analysed only paediatric data and had 31 cases (72 %) of these lesions in children below 3 years of age which is comparable to other reports.…”

Growing Skull Fracture of Temporal Bone in Adults: A Case Report and Literature Review

“…The increasing pressure on fracture edges created by brain pulsation and herniation of intracranial tissue would prevent them from apposition and healing. 5,6,8,11,12,19 In consistent with previous studies, 20,8 we don’t think the intracranial expansive force of CSF cyst can result in elevated intracranial pressure unless there was hydrocephalus (in our literatures review, such cases or speculation were not reported) because in the course of GSF, skull will accordingly enlarge. And surgical repairment of dura matter and cranium is the most widely applied treatment.…”

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

“…13 A GSF can be associated with a leptomeningeal cyst, encephalomalacia, cystic parenchymal lesions, porencephaly, unilateral ventricular dilatation, hydrocephalus, pseudomeningoencephalocele, intraventricular cyst and lytic bone lesion mimicking a skull tumor. 2,13,16,17 In addition, in this report orthostatic sinking of the scalp over the GSF such as SSFS is shown. The SSFS has been described as one of the causes of neurological deterioration after a large craniectomy during a neurosurgical procedure due to the compression of the skin flap onto the brain.…”

Surgical results of growing skull fractures in children: a single centre study of 43 cases

“…Ours being a tertiary care trauma centre, delayed referral is a common phenomenon; this combined with parent and physicians' ignorance contributed to the late presentation of our patients. Ersahin et al [4] reported no recurrence with duraplasty alone in majority of their cases and similar results have been noted by other authors as well [3,2,15,7]. We performed duraplasty in four of our cases with smaller defects and achieved satisfactory results (Fig.…”

“…Also, brain grows rapidly in the first 2 years which widens the defect and thus they are more prone to GSF. Alternatively, in these children, the skull is thinner and deformable and dural tear occurs because of this deformation [3, 4,29,30]. In our study, we analysed only paediatric data and had 31 cases (72 %) of these lesions in children below 3 years of age which is comparable to other reports.…”

Growing Skull Fracture of Temporal Bone in Adults: A Case Report and Literature Review

“…The increasing pressure on fracture edges created by brain pulsation and herniation of intracranial tissue would prevent them from apposition and healing. 5,6,8,11,12,19 In consistent with previous studies, 20,8 we don’t think the intracranial expansive force of CSF cyst can result in elevated intracranial pressure unless there was hydrocephalus (in our literatures review, such cases or speculation were not reported) because in the course of GSF, skull will accordingly enlarge. And surgical repairment of dura matter and cranium is the most widely applied treatment.…”

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

“…13 A GSF can be associated with a leptomeningeal cyst, encephalomalacia, cystic parenchymal lesions, porencephaly, unilateral ventricular dilatation, hydrocephalus, pseudomeningoencephalocele, intraventricular cyst and lytic bone lesion mimicking a skull tumor. 2,13,16,17 In addition, in this report orthostatic sinking of the scalp over the GSF such as SSFS is shown. The SSFS has been described as one of the causes of neurological deterioration after a large craniectomy during a neurosurgical procedure due to the compression of the skin flap onto the brain.…”