Surgical Treatment of Growing Skull Fracture: Technical Aspects of Cranial Bone Reconstruction

Abstract

Background: Growing skull fracture (GSF) is a rare, posttraumatic complication observed mainly in young infants. In GSF, the skull fracture associated with an underlying dural tear gradually expands due to herniation of the intracranial tissue into the fracture site. Many reports have discussed GSF from various points of view. However, only a few studies have focused on the details of cranial reconstruction. The present study aims to redress this omission by shedding some light on bone work in GSF surgery. Methods: Patients registered in the institutional database who underwent surgical repair of GSF were retrospectively reviewed. Results: Four patients underwent surgical repair for GSF. The site of injury was parietal in 3 patients and occipital in 1 patient . Age at the time of injury ranged from 3 months to 1 year 5 months (mean: 7 months). The duration from injury to surgery ranged from 5 to 7 months (mean: 5 months). In all patients, dural reconstruction was performed with autologous periosteum and cranial reconstruction was performed with an autologous calvarial bone graft. Regardless of the age distribution, split bone grafting was possible for all patients. Conclusion: To diagnose GSF promptly and thereby reduce the risk of neurologic sequelae, careful observation of the course, and education of the patients’ parents are desirable. Although most children with GSF are under 3 years old, the age before the formation of the diploic layer, split bone grafts should be considered for the treatment of GSF to reduce the risk of residual cranial bone defects.

Neglected Growing Skull Fracture: Details on Peroperative Findings and Surgical Repair

“…CT with 3D skull reconstruction is the most useful investigation tool to describe the skull defect. Most cranial defects have ragged and scalloped edges with markedly thickened or divided bone margins [3,7]. Careful examination of the herniated contents is needed since it has implications in treatment modalities to choose [1].…”

“…Careful examination of the herniated contents is needed since it has implications in treatment modalities to choose [1]. MRI, when available, provides more details such as the extent of dural defect, leptomeningeal cyst, encephalomalacic herniated brain, porencephalic cyst and dilatation of the ipsilateral ventricle [2,3].…”

“…The scalp incision must be well chosen to allow for adequate bony removal and dural repair. Thus, a large skin galea flap is recommended to obtain a satisfactory intraopeartive view [1,3,7]. Chen et al [11] described an extremely rare case of intradiploic encephalocele following a linear skull fracture in an 8-year-old boy.…”

“…It commonly develops after a head trauma with a linear skull fracture and an underlying dural tear [3]. Delayed diagnosis and improper management can lead to severe complications [2,3]. Herein we report a case of neglected GSF treated in our department.…”

“…Growing skull fracture is a very rare complication following traumatic head injury in infants and toddlers below 3 years [1,2]. It commonly develops after a head trauma with a linear skull fracture and an underlying dural tear [3]. Delayed diagnosis and improper management can lead to severe complications [2,3].…”