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Singhal GD, Atri S, Suggala S, Jaluka D, Singhal S, Shrivastava AK. Growing Skull Fractures; Pathogenesis and Surgical Outcome. Asian J Neurosurg 2021; 16:539-548. [PMID: 34660366 PMCID: PMC8477810 DOI: 10.4103/ajns.ajns_183_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/01/2018] [Accepted: 01/26/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We performed a retrospective study of 67 patients and their data for radiological investigations by serial Xrays, computed tomography, magnetic resonance imaging, uniform surgical procedure of craniotomy. The results were analyzed to determine the natural course of the disease, anatomical changes at various intervals following trauma, and outcome of surgical procedure in terms of cranial reconstruction, seizures, and progress in neurological deficit. RESULTS Among 67 patients, 34 (50.74%) were male and 33 (49.26%) were female patients. About 86.67% of patients sustained the injury before the age of 3 years. Development of seizures in 28 patients (41.80%) is the most common symptom. In our study, 43.28% of patients (29 cases) had a combination of Type I and II of growing skull fracture. The dural defects confirmed in all cases were nearly twice (average 1.42) as large as the bone defects. All patients under the age of 3 years with diastatic skull fracture should be closely followed up and should be examined 2-3 months later to look for evidence of a growing skull fracture. Linear fractures and burst fractures in an infant with a scalp swelling must be corrected early to prevent a growing skull fracture. CONCLUSION Early management can avoid difficult surgical dissection and progressive neurological sequelae seen with delayed intervention. Surgical correction results in the prevention of brain shift and increase in meningocerebral cicatrices. Meticulous surgery and vigilant postoperative care reduce the morbidity and mortality. In our opinion, the autologous material is the best choice because of its tissue compatibility, convenience, inexpensiveness, and rare rate of infection.
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Affiliation(s)
- G D Singhal
- Department of Neurosurgery, G B Pant Hospital, New Delhi, India
| | - Sanjeev Atri
- Department of Neurosurgery, NIMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Sudheer Suggala
- Assistant Professor of Neurosurgery, Doctor PSIMS and RF, Vijayawada, Andhra Pradesh, India
| | - Dinesh Jaluka
- Department of Neurosurgery, G Kar Medical College and Hospital, Kolkata, India
| | - Shakti Singhal
- Department of Anesthesia, Gajara Raja Medical College, Gwalior, Madhya Pradesh, India
| | - A K Shrivastava
- Department of Neurosurgery, G B Pant Hospital, New Delhi, India
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Zeitoun IM, Ebeid K, Soliman AY. Growing skull fractures of the orbital roof: a multicentric experience with 28 patients. Childs Nerv Syst 2021; 37:1209-1217. [PMID: 33029727 DOI: 10.1007/s00381-020-04918-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Growing skull fracture (GSF) is a rare condition that may complicate pediatric head trauma. Patients may present with delayed-onset neurological manifestations. AIM This study aims to highlight the different presentations, methods of evaluation, treatment modalities, and outcomes in patients with orbital roof GSF. METHODS This retrospective multicentric cohort study reviewed the hospital records of children with GSF who presented at the Craniomaxillofacial Plastic Surgery Department, and Neurosurgery Department with Otorhinolaryngology Department (Maxillofacial unit), from 2011 to 2020. The collected data included age, gender, delay, manifestations, findings of imaging techniques, surgical treatment, complications, and satisfaction of patients' parents. RESULTS Twenty-eight patients with orbital roof GSF were included in this study. Most of the patients (82.1%) were boys, and the mean (SD) age was 5 (2) years old. Head trauma was caused by falls in all cases. Clinical manifestations included eyelid swelling (75%), pulsatile proptosis (25%), headache (17.9%), and seizures (10.7%). The mean (SD) diameter of bony defects was 24.3 (8.7) mm. Duraplasty alone was performed in 57.1%, while dura-cranioplasty was done in 42.9% of patients. Dural reconstruction was done using pericranial graft in 82.1% and artificial grafts in 17.9% of patients. Most of the parents (95%) were absolutely satisfied. No mortalities or recurrence of symptoms were recorded. The median follow-up period after surgery was 3.9 years. CONCLUSION Orbital roof GSF should be considered among the differential diagnoses in pediatric patients with history of head trauma presenting with ocular and/or neurological manifestations. Duraplasty is mandatory in all cases, whereas cranioplasty is required mainly in cases with large bony defects more than 25 mm. Prognosis in most patients was good both subjectively and objectively.
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Affiliation(s)
- Ibrahim Mohamed Zeitoun
- Faculty of Dentistry, Alexandria University, 18 Koliat el tib st., Ramlah station, Alexandria, 21526, Egypt
| | - Kamal Ebeid
- Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
| | - Ahmed Y Soliman
- Neurosurgery Department Faculty of Medicine , Tanta University , 31527, Tanta, Egypt.
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Singh I, Rohilla S, Siddiqui SA, Kumar P. Growing skull fractures: guidelines for early diagnosis and surgical management. Childs Nerv Syst 2016; 32:1117-22. [PMID: 27023392 DOI: 10.1007/s00381-016-3061-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Growing skull fracture (GSF) is a rare complication of pediatric head trauma and causes delayed onset neurological deficits and cranial defect. GSF usually develops following linear fracture with underlying dural tear resulting in herniation of the brain. Early diagnosis and treatment are essential to avoid complications. However, there are no clear-cut guidelines for the early diagnosis of GSF. The present study was conducted to identify the criteria for the early diagnosis of GSF. MATERIAL AND METHODS From 2010 to 2015, all pediatric patients of head trauma with linear fracture were evaluated. Patients of age <5 years with cephalhematoma, bone diastasis of 4 mm or more with underlying brain contusion were subjected to contrast brain MRI to find out the dural tear and herniation of the brain matter. Patients with contrast MRI showing dural tear and herniation of the brain matter were considered high risk for the development of GSF and treated surgically within 1 month of trauma. Patients with contrast brain MRI not showing dural tear and herniation of the brain matter were regularly followed for any signs of GSF. RESULTS A total of 20 patients were evaluated, out of which 16 showed dural defects with herniation of the brain matter and were subjected to duraplasty. Four patients in which MRI did not show dural tear and herniation of the brain matter were regularly followed-up and have not shown any sign of GSF later on follow-up. CONCLUSION Early diagnosis of GSF can be made based on the four criteria, i.e., (1) age <5 year with cephalhematoma, (2) bone diastasis 4 mm or more (3) underlying brain contusion (4) contrast MRI showing dural tear and herniation of the brain matter. Dural tear with herniation of the brain matter is the main etiopathogenic factor for the development of GSF. Early diagnosis and treatment of GSF can yield a good outcome.
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Affiliation(s)
- Ishwar Singh
- PT.BD Sharma University of Health Sciences Rohtak, Rohtak, Haryana, India.
| | - Seema Rohilla
- PT.BD Sharma University of Health Sciences Rohtak, Rohtak, Haryana, India
| | | | - Prashant Kumar
- PT.BD Sharma University of Health Sciences Rohtak, Rohtak, Haryana, India
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Jain S, Gandhi A, Sharma A, Mittal RS. Growing skull fracture with cerebrospinal fluid fistula: A rare case report and its management strategies. Asian J Neurosurg 2015; 10:229-31. [PMID: 26396614 PMCID: PMC4553739 DOI: 10.4103/1793-5482.161182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The growing skull fracture (GSF) occurs in younger age group as a sequel of trauma. The most common site of these lesions is parietal region. Here we are presenting a case of GSF of posterior fossa with cerebrospinal fluid (CSF) fistula. As per literature, we have not found a single case of GSF in the posterior fossa with CSF fistula. The aim of this presentation is discussing the unusual presentation of GSF and its management.
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Affiliation(s)
- Saurabh Jain
- Department of Neurosurgery, SMS Hospital, Jaipur, Rajasthan, India
| | - Ashok Gandhi
- Department of Neurosurgery, SMS Hospital, Jaipur, Rajasthan, India
| | - Achal Sharma
- Department of Neurosurgery, SMS Hospital, Jaipur, Rajasthan, India
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Congenital duplication of the superior sagittal sinus and parietal encephalocele after vacuum extraction delivery. Acta Neurochir (Wien) 2010; 152:713-6. [PMID: 19639246 DOI: 10.1007/s00701-009-0470-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
Abstract
A newly-born infant with a congenital dural and bony defect and an associated short-segmented duplication of the superior sagittal sinus suffered from herniation and infarction of parietal brain tissue secondary to vacuum extraction. This ultimately led to the formation of a subgaleal cerebrospinal fluid (CSF) collection. Initial operative closure of the encephalocele was performed by attaching a galeal flap to the periostium surrounding the congenital defect. As the bony defect developed characteristics of a growing fracture later on, dural repair, transplantation of a split-bone flap and, finally, the insertion of a ventriculoperitoneal shunt became necessary. This case affirms that stringent indication and cautious usage of vacuum-assisted delivery is strongly recommended, especially in view of the possibility that undetected congenital cranial, vascular and/or cerebral alterations may be present.
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Abstract
Birth injury of the scalp, skull and central nervous system (CNS) is a well-recognized complication of a difficult delivery. The rate of birth trauma has dropped precipitously and now accounts for less than 2% of neonatal deaths. Despite this dramatic decrease in birth-trauma mortality significant injuries still occur. A variety of risk factors clearly predispose certain infants to birth-related injury. Recent neuroradiology studies indicate that intracranial hemorrhage, even in asymptomatic infants, is not rare. Pathologists' (neuropathologists and forensic pathologists) appreciation of the spectrum of birth injuries and their sequelae is critical in order to be able to distinguish these from inflicted injuries and post-mortem changes.
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Affiliation(s)
- Ross Reichard
- Department of Pathology, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Bobinski L, Boström S, Zsigmond P, Theodorsson A. Leptomeningeal cyst due to vacuum extraction delivery in a twin infant. Acta Neurochir (Wien) 2007; 149:319-23; discussion 323. [PMID: 17273888 DOI: 10.1007/s00701-006-1096-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Accepted: 12/12/2006] [Indexed: 12/01/2022]
Abstract
A rare case of a leptomeningeal cyst is reported in a twin male neonate delivered using a vacuum extractor, who presented a huge, non-pulsating, oedematous mass overlying the frontal fontanelle after birth. The mass was initially diagnosed as a cephalo haematoma. Ultrasonography indicated intracranial bleeding and a subsequent CT scan revealed an intraparenchymal bleeding above the left frontal horn, combined with a thin, left-sided, subdural haematoma and subarachnoid haemorrhage in the left Sylvian fissure. Apart from a bulging soft and round formation (2 x 2 x 3 cm) next to the anterior fontanel growing since birth, the neurological development of the infant was normal. MRI examination at the age of 7 months revealed that it consisted of a cystic mass (leptomeningeal cyst) connected to the left frontal horn, stretching right through the brain and also penetrating the dura mater. No signs of the perinatal haematomas were observed at this time. Surgical treatment, with fenestration of the cyst into the frontal horn and a watertight duraplasty with a periosteal flap and thrombin glue covered by small bone chips, was performed at 9 months of age. Due to a residual skull bone defect a second cranioplasty with autologous skull bone was performed three and half years later. During a follow-up period of 12 years the neurological and psychological development of the boy has been indistinguishable to that of his twin brother, indicating the satisfactory outcome of the treatment.
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Affiliation(s)
- L Bobinski
- Department of Neurosurgery, University Hospital, Linköping, Sweden
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de P Djientcheu V, Njamnshi AK, Ongolo-Zogo P, Kobela M, Rilliet B, Essomba A, Sosso MA. Growing skull fractures. Childs Nerv Syst 2006; 22:721-5. [PMID: 16404643 DOI: 10.1007/s00381-005-0010-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2005] [Revised: 06/27/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Growing skull fractures are a rare complication of head injuries (Ersahin et al. in Neurosurg Rev 23:139-144, 2000; Hayashi et al. in Childs Nerv Syst 13:349-351, 1997; Ramamurthi and Kalyanaraman in Neurosurgery 32:427-430, 1970; Zegers et al. in Eur J Pediatr 162:556-557, 2003). Although early diagnosis and prompt treatment are important to prevent the underlying progressive brain damage, the clinical presentation and the morphological investigations are rarely specific or sensitive shortly after the trauma. DISCUSSION The authors present three cases of growing skull fractures: the use of ultrasonography (US) via the fracture line contributed to early diagnosis and prompt treatment in two cases. US was not performed in the third case, and this delayed management. Treatment consisted of a watertight duraplasty with a free flap of pericranium without cranioplasty. US via the fracture line appears to be a sensitive and reliable method of detecting the dural tears in the early stages of growing skull fractures. CONCLUSION Duraplasty alone with a flap of pericranium remains the simplest and least expensive method of treatment. Cranioplasty is not necessary in young children.
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Affiliation(s)
- V de P Djientcheu
- Neurosurgery Service, Central Hospital of Yaounde, Yaounde, Cameroon
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Abstract
This article summarizes the current state of knowledge of obstetric vacuum extraction. The discussed topics include the history of vacuum extraction, indications and contraindications, technique of the procedure, currently marketed instruments, special uses of the vacuum extractor, comparison of vacuum extraction with forceps delivery, and maternal and fetal outcomes. Areas of controversy are identified and discussed. Vacuum extraction is replacing forceps as the preferred method of instrumental delivery.
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Affiliation(s)
- P Miksovsky
- Department of Obstetrics and Gynecology, School of Medicine, University of South Dakota, Sioux Falls 57105, USA.
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Affiliation(s)
- K J Stewart
- Craniofacial and Neonatal Units, Chelsea and Westminster Hospital, London, UK
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