Growing skull fractures: progressive evolution of brain damage and effectiveness of surgical treatment

Gb, Scarfò; Mariottini, Aldo; Tomaccini, D; L, Palma

doi:10.1007/bf00272120

Cited by 40 publications

(27 citation statements)

References 11 publications

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“…CT displays cysts, parenchymal injury, and ventricular morphology in addition to the bony defect. 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].…”

Section: Discussionmentioning

confidence: 91%

“…Dural tear has been considered the single most important factor in the development of GSF [24][25][26][27][28]. In 1961, 141 Lende and Erickson [10] emphasized four essential features: (1) skull fracture in infancy or early childhood, (2) dural tear at the time of fracture, (3) brain injury beneath the fracture, and (4) subsequent enlargement of the fracture to form a cranial defect.…”

Section: Discussionmentioning

confidence: 99%

“…Moss et al [43] even reported intrauterine GSF. Neurological deficits such as hemiparesis, squinting, and visual field defects may accompany the scalp swelling [4,7,16,27,30,35,37,41,44,45]. Symptoms and signs may also vary with the growing fracture's location.…”

Section: Discussionmentioning

confidence: 99%

“…Plain skull X-ray is an inexpensive and invaluable tool in the diagnosis of GSF. Diastatic skull fracture is always shown on the skull X-rays made at the time of injury [4,22,25,27,37,44,45], and bone defects or lucency are shown after a period of time. CT displays cysts, parenchymal injury, and ventricular morphology in addition to the bony defect.…”

Section: Discussionmentioning

confidence: 99%

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Growing skull fractures (craniocerebral erosion)

Erşahin¹,

Gülmen

Palali

et al. 2000

Neurosurg Rev

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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.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Growing skull fractures (craniocerebral erosion)

Erşahin¹,

Gülmen

Palali

et al. 2000

Neurosurg Rev

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“…In general a dilated ipsilateral ventricle is described in most cases of GSF [ 14,17,18], This is explained by loss of normal dural tensile forces after a dural tear [19] with underlying structural brain injury and brain atrophy. In our patient the initial traumatic event produced an imme diate dural rupture of the brain cortex and white matter as well.…”

Section: Discussionmentioning

confidence: 99%

Rapid Evolution of a Growing Skull Fracture after Vacuum Extraction in Case of Fetal Hydrocephalus

Hes¹,

Jong²,

Geuze³

et al. 1997

Pediatr Neurosurg

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Vacuum extraction in nonprogressive labor is relatively safe. Only a few major complications have been mentioned. This article describes the rapid development of a growing skull fracture associated with a porencephalic cyst and parenchymal brain damage after a difficult vacuum extraction in a patient with congenital hydrocephalus and a thoracic meningomyelocele. The diagnostic and therapeutic management is discussed.

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Head Trauma in Children Younger Than 2 Years

Gruskin¹,

Schutzman²

1999

Arch Pediatr Adolesc Med

110

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To determine the incidence of skull fracture (SF) and intracranial injury (ICA) among children younger than 2 years evaluated in a pediatric emergency department for head trauma; whether historical features and/or physical findings are predictive of injury type; and whether clinical criteria could allow a selective approach to radiographic imaging.Design: Retrospective medical record review.Setting: Tertiary pediatric emergency department.Patients: Case series of 278 children aged younger than 24 months evaluated for head injury.Main Outcome Measures: Presence of SF and/or ICA.Results: Diagnoses at discharge included 227 minor head injuries, 39 isolated SF, 9 ICA with SF, and 3 isolated ICA. Children younger than 12 months had the highest incidence of SF/ICA (29%) vs 4% for children aged 13 to 24 months (PϽ.001). Seven percent of complications from SF/ICA resulted from falls 3 ft (0.9 m) or less. Incidence of behavioral change, loss of consciousness, emesis, and seizures did not differ significantly between those with minor head injuries and those with SF/ICA. Scalp abnormalities were more common in children with SF/ ICA (PϽ.001). Sixty-two percent of children with isolated SF and 58% of children with ICA had no history of loss of consciousness, emesis, seizure, or behavioral change. Ninety-two percent of children with isolated SF and 75% of children with ICA had normal levels of consciousness and nonfocal neurologic examinations at diagnosis. Among children who fell 3 ft (0.9 m) or less and had no loss of consciousness, emesis, seizure, behavioral change, or scalp abnormality, none of 31 (95% confidence interval [CI], 0-0.10) children younger than 24 months and none of 20 (95% CI, 0-0.15) children younger than 12 months had SF/ICA.Conclusions: Both SF and ICA are common in children younger than 2 years evaluated for head trauma. Children younger than 12 months are at highest risk. Injuries resulted from relatively minor falls and occurred in alert, neurologically normal children. Clinical signs and symptoms were insensitive predictors of SF/ICA; however, a grouping of features (fall Յ3 ft [0.9 m], no history of neurologic symptoms, and normal scalp physical examination results) identified a subset of children at low risk for complications.

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Growing skull fractures: progressive evolution of brain damage and effectiveness of surgical treatment

Cited by 40 publications

References 11 publications

Growing skull fractures (craniocerebral erosion)

Growing skull fractures (craniocerebral erosion)

Rapid Evolution of a Growing Skull Fracture after Vacuum Extraction in Case of Fetal Hydrocephalus

Head Trauma in Children Younger Than 2 Years

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