GROWING SKULL FRACTURE – CASE REPORT AND REVIEW OF THE LITERATURE
DOI:
https://doi.org/10.6016/ZdravVestn.2298Keywords:
infants, fracture line, dural tear, scalp massAbstract
Background. Growing skull fracture is a progressive enlargement of a fracture. It produces a cranial defect. It is a rare complication of head injury, occurring almost exclusively in infants and children under the age of three. It rarely occurs latter than 6 months from the injury. This condition requires both a widely separated fracture and a dural tear. Most growing skull fractures are brought to medical attention when the palpable mass is noticed. If left untreated it might lead to neurological deficit and/or epilepsy. MR combined with CT scan and plain skull X-rays is and indispensable procedure for diagnosis of growing skull fracture. Treatment is surgical with dural closure mandatory.
Patient and methods. A 10-month-old male infant felt down stairs and suffered a blow in his right parietal region. On admission, he was conscious with Children Coma Scale Score (CCS) 11. He had no neurological deficits. Skull X-ray just after the injury showed a diastatic right parietal skull fracture about 5 mm in diameter spreading from lambdoid toward the sagittal suture. CT scan upon admission revealed the above mentioned fracture line but no brain contusion. Ten days later, he was discharged home. Repeated skull films revealed growth of a fracture line. 3D CT demonstrated a growing skull fracture. MR revealed cortical atrophy, cystic lesion beneath the bone defect and subgaleal cerebral herniation. He was operated 7 months after injury. A dural reconstruction with the periost graft and a cranioplasty with titanium mesh were performed. The postoperative course was uneventful except one seizure. After 2 weeks, he was discharged with no neurological deficit.
Conclusions. This entity consists of a skull fracture with an underlying dural tear those courses with a progressive enlargement of the fracture to produce a cranial defect. Physiologic growth of the brain contributes to the fracture enlargement. This complication must be recognized early in order to obtain good results after surgical therapy.
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