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Tahir MZ, Mirza FA, Thompson DNP, Hayward R. Early Intervention and Use of Autologous Grafts in Growing Skull Fractures Results in Better Outcomes: Experience From a Tertiary Pediatric Neurosurgery Center. Oper Neurosurg (Hagerstown) 2024; 27:279-286. [PMID: 38560818 DOI: 10.1227/ons.0000000000001130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/17/2023] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Growing skull fracture (GSF) is a rare complication of pediatric head trauma. Definitive treatment is surgical repair. We have attempted to assess whether use of autologous grafts for duraplasty and cranioplasty leads to better outcomes. We have also attempted to understand how timing of surgery might affect the degree of underlying damage to cortical tissue. METHODS This is a single-center retrospective observational study based on review from the Great Ormond Street Hospital Neurosurgery prospective surgical database. All patients undergoing surgery for GSF repair between 1991 and 2015 were included. Surgical techniques included split calvarial grafts in 4 patients, whereas rest had full-thickness bone grafting. In all cases with full-thickness graft, the donor site was covered with morselized bone chips mixed with fibrin glue (Salami technique). RESULTS Twenty-eight patients were identified (16 males, 12 females). The average age at the time of injury was 13 months. The mean duration of onset of symptoms from the time of injury was 4.4 months. The time interval from symptom onset to surgical repair was 5.92 months. Seven patients had Type I GSF (leptomeningeal cyst with minimal brain parenchyma), 13 had type II (hernia containing gliotic brain), and 8 had type III (porencephalic cyst extending through the skull defect into subgaleal space). Patients with delayed presentation had severe brain injury (Type III) and had more long-term complications (refractory epilepsy requiring temporo-occipito-parietal disconnection and development of hydrocephalus requiring ventriculoperitoneal shunt insertion). CONCLUSION Autologous pericranium for duraplasty and split-thickness bone graft or the Salami technique are recommended for cranioplasty. Synthetic materials should be used if the index operation fails or there are complications. Patients with high-risk findings should be identified at the time of initial presentation and followed up in clinic early to prevent onset of neurological deficit. Early repair is associated with better neurological outcomes.
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Affiliation(s)
- M Zubair Tahir
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London , UK
| | - Farhan A Mirza
- Department of Neurological Surgery, Kentucky Neuroscience Institute (KNI), University of Kentucky, Lexington , Kentucky , USA
| | - Dominic N P Thompson
- Department of Pediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London , UK
| | - Richard Hayward
- Department of Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London , UK
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Şık N, Öztürk A, Yılmaz D, Duman M. The Role of Ultrasound in Pediatric Skull Fractures: Determination of Fracture and Optic Nerve Sheath Diameter Measurements. Pediatr Emerg Care 2023; 39:91-97. [PMID: 36719390 DOI: 10.1097/pec.0000000000002895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma. METHODS Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images. RESULTS There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8-98.6) and 96.8% (95% CI, 89.1-99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1-98.8), and the negative predictive value was 95.3% (95% CI, 87.3-98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs. CONCLUSIONS When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.
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Affiliation(s)
- Nihan Şık
- From the Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Kozaki Y, Nonaka M, Miki K, Tanaka H, Abe H, Inoue T. Endoscopic-assisted Duraplasty with Collagen Matrix for Growing Skull Fracture: A Case Report. NMC Case Rep J 2022; 8:201-206. [PMID: 35079464 PMCID: PMC8769400 DOI: 10.2176/nmccrj.cr.2020-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/14/2020] [Indexed: 11/20/2022] Open
Abstract
Growing skull fracture (GSF) is a rare complication of pediatric head injury. Early diagnosis and immediate surgical intervention are required for the prevention of irreversible brain damage. Surgical management involves water-tight closure of the dural defect and commonly uses autologous materials because of tissue compatibility; however, a large skin flap and craniotomy are necessary to harvest the autologous materials and repair the dural defect. We describe a successful case of endoscopic-assisted duraplasty using collagen matrix in a female infant suffering from early phase GSF. A 4-month-old female infant presented with a GSF. We surgically treated her because the fracture width progressively expanded 6 days post-injury. A zigzag skin incision was made, and the extent of the skull fracture and dural laceration was observed using an endoscope. Utilizing the collagen matrix, duraplasty was performed to completely seal the dural defect. Subsequently, cranioplasty was performed and the opposite sides of the fracture margins were drawn and bonded by nylon suture. Postoperatively, the patient did not develop any complication or experience recurrence. This is the first report of duraplasty using collagen matrix in GSF, and the collagen matrix can be used as a dural substitute. This novel technique was safe and a less invasive surgical approach for treating patients with GSF.
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Affiliation(s)
- Yuki Kozaki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Masani Nonaka
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Koichi Miki
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Hideaki Tanaka
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Hiroshi Abe
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, Fukuoka University Hospital and School of Medicine, Fukuoka University, Fukuoka, Fukuoka, Japan
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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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Kulkarni AV, Dikshit P, Devi BI, Sadashiva N, Shukla D, Bhat DI. Unusual Complication of a Neglected Growing Skull Fracture. Pediatr Neurosurg 2021; 56:179-183. [PMID: 33626526 DOI: 10.1159/000513102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The growing skull fracture (GSF) is a rare complication seen after head injury in infants and young children. It occurs due to a wide skull defect with underlying dural defect and changes in pressure gradients within skull cavity. Neglected cases may develop progressive neurological deficits and complications after second head trauma. Case Discussion: We present a 14-year-old child who developed sudden-onset, diffuse, soft, fluctuant, circumferential swelling of the head after a road traffic accident. He had sustained a head injury at the age of 3-months leading to an asymptomatic soft swelling over the skull which was left untreated. Present CT scan of the brain showed a bony defect with ragged edges and cerebrospinal fluid (CSF) collection in subgaleal space circumferentially. He underwent exploration, duroplasty, and cranioplasty and had a good outcome. CONCLUSION Neglected GSF can rupture and cause diffuse subgaleal CSF collection. It should be managed with dural repair and cranioplasty.
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Affiliation(s)
- Akshay Vijay Kulkarni
- Department of Neurosurgery, National institute of Mental Health and Neurosciences, Bengaluru, India
| | - Priyadarshi Dikshit
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - B Indira Devi
- Department of Neurosurgery, National institute of Mental Health and Neurosciences, Bengaluru, India,
| | - Nishanth Sadashiva
- Department of Neurosurgery, National institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhaval Shukla
- Department of Neurosurgery, National institute of Mental Health and Neurosciences, Bengaluru, India
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You Y, Romero J, Diaz G, Herman J, Siu A, Evans R. Cranial floor fracture: A growing orbital roof fracture with encephalocele - Case Report. Int J Surg Case Rep 2020; 78:172-175. [PMID: 33359964 PMCID: PMC7758275 DOI: 10.1016/j.ijscr.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/02/2020] [Accepted: 12/02/2020] [Indexed: 11/26/2022] Open
Abstract
Orbital roof fractures are among the rarest of craniofacial fractures. Detailed craniofacial examination and high-resolution CT imaging is necessary for diagnosis. A challenging aspect of the fractures is their “growing” nature. A growing encephalocele can complicate the treatment of orbital roof fractures. Orbital roof fractures can become progressively worse secondary to brain swelling.
Orbital roof fractures are among the rarest of craniofacial fractures. The mechanism of injury is typically a high-impact blunt force vector directly to the orbit or forehead. Most patients are males between 20 and 40 years old, involved in motor vehicle accidents. Although most orbital roof fractures are managed conservatively, there is a significant risk of ophthalmologic and neurologic complications. Detailed craniofacial examination and high-resolution CT imaging is necessary for diagnosis. A multidisciplinary team approach is required for these challenging fractures.
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Affiliation(s)
- Yuchen You
- Graduate Medical Education, Community Memorial Health System, Ventura, CA, USA.
| | - Javier Romero
- Graduate Medical Education, Community Memorial Health System, Ventura, CA, USA
| | - Graal Diaz
- Graduate Medical Education, Community Memorial Health System, Ventura, CA, USA
| | - James Herman
- Department of General Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Alan Siu
- Ventura County Neuroscience Center, Ventura County Medical Center, Ventura, CA, USA
| | - Robin Evans
- Department of General Surgery, Ventura County Medical Center, Ventura, CA, USA
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Marchini G, Martín Muñoz D, Vladic Stjernholm Y. A parietal bone fracture with subgaleal and subdural hemorrhage in association with vacuum extraction delivery. Clin Case Rep 2020; 8:2103-2106. [PMID: 33235736 PMCID: PMC7669393 DOI: 10.1002/ccr3.2119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/18/2018] [Accepted: 01/26/2019] [Indexed: 11/10/2022] Open
Abstract
A neonatal parietal bone fracture was complicated by subgaleal and subdural hematomas after a vacuum extraction delivery. Low-dose computer tomography visualized a comminuted skull fracture. Close observation of infants delivered by vacuum extraction, conservative management after a skull fracture, and further studies on vacuum traction monitoring are warranted.
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Affiliation(s)
- Giovanna Marchini
- Departments of NeonatologyKarolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Daniel Martín Muñoz
- Department of NeuroradiologyKarolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Ylva Vladic Stjernholm
- Women’s and Children’s HealthKarolinska University Hospital and Karolinska InstitutetStockholmSweden
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Harsh V, Gond PK, Kumar A. Post-Traumatic Diploic Leptomeningeal Cyst with Bilateral Posterior Cranial Fossa Epidural Hygroma: A Management Dilemma? World Neurosurg 2020; 140:258-261. [PMID: 32445897 DOI: 10.1016/j.wneu.2020.05.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Post-traumatic diploic leptomeningeal cyst with bilateral posterior cranial fossa epidural hygroma is a rare complication after calvarial fracture. Very few cases have been reported to date; hence, there are no specific guidelines for the management of these cases. CASE DESCRIPTION A 4-year-old boy was brought to the emergency department after suffering from head trauma caused by a fall from a rooftop where he was treated conservatively at a local hospital. Later, he developed swelling in the occipital region and was brought to the department of neurosurgery where he was operated on. After the first surgery, recurrence of swelling was seen after a postoperative period of 2 months, and computed tomography scan reported persistent epidural hygroma with extension into the subcutaneous space. The second surgery was performed, and 12-month follow-up did not show any recurrence of swelling in the patient. CONCLUSIONS Post-traumatic leptomeningeal cyst is commonly associated with occipital injury. The causes are as follows: the dura is very loosely attached to the intracranial lamina in young children, injury to the skull results in potential epidural space, and any tear or breach in the meninges leads to accumulation of cerebrospinal fluid in these spaces giving rise to cystic swelling. Watertight duroplasty with trials of duro-periosteal hitching has been described in the management of these cases.
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Affiliation(s)
- Viraat Harsh
- Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi, Odisha, India
| | - Preeti K Gond
- Department of Surgery, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Anil Kumar
- Department of Neurosurgery, Rajendra Institute of Medical Sciences, Ranchi, Odisha, India.
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Pediatric Skull Fracture Characteristics Associated with the Development of Leptomeningeal Cysts in Young Children after Trauma: A Single Institution's Experience. Plast Reconstr Surg 2020; 145:953e-962e. [PMID: 32332544 DOI: 10.1097/prs.0000000000006745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Currently, the pathogenesis of leptomeningeal cysts, also known as growing skull fractures, is still debated. The purpose of this study was to examine the specific skull fracture characteristics that are associated with the development of growing skull fractures and describe the authors' institutional experience managing this rare entity. METHODS A retrospective cohort study was performed that included all patients younger than 5 years presenting to a single institution with skull fractures from 2003 to 2017. Patient demographics, cause of injury, skull fracture characteristics (e.g., amount of diastasis, linear versus comminuted fracture), concomitant neurologic injuries, and management outcomes were recorded. Potential factors contributing to the development of a growing skull fracture and neurologic injuries associated with growing skull fractures were evaluated using univariate logistic regression. RESULTS A total of 905 patients met the authors' inclusion criteria. Of these, six (0.66 percent) were diagnosed with a growing skull fracture. Growing skull fractures were more likely to be comminuted (83.3 percent versus 40.7 percent; p = 0.082) and to present with diastasis on imaging (100 percent versus 26.1 percent; p < 0.001; mean amount of diastasis, 7.1 mm versus 3.1 mm; p < 0.001). Univariate logistic regression analysis confirmed the role of a comminuted fracture pattern (OR, 7.572) and the degree of diastasis (OR, 2.081 per mm diastasis) as significant risk factors for the development of growing skull fractures. CONCLUSIONS The authors' analysis revealed that fracture comminution and diastasis width are associated with the development of growing skull fractures. The authors recommend dural integrity assessment, close follow-up, and early management in young children who present with these skull fracture characteristics. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Yan XH, Qiu K, Gao Y, Ren J, Cheng D, Pang W, Song Y, Yang W, Yu R, Zhao Y. Growing Skull Fracture of Temporal Bone in Adults: A Case Report and Literature Review. EAR, NOSE & THROAT JOURNAL 2020; 99:654-657. [PMID: 32207331 DOI: 10.1177/0145561320914774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Growing skull fracture (GSF) is an uncommon post-traumatic complication, which accounts for approximately 0.05% to 1% of all skull fractures. Delayed diagnosis of GSF in adulthood is rare and often involved with a variety of neurological symptoms. Here, we reported an adult patient, with an interval of 17 years from initial head trauma to first diagnosis of GSF. The patient complained of short periods of fainting and bilateral visual hallucinations, with a hard palpable bulge around his right occipitomastoid suture region. Computed tomographic imaging demonstrated an arachnoid cyst extending into right mastoid cavity. Consequently, the delayed diagnosis of GSF was confirmed, and the patient was managed with duroplasty and cranioplasty. At the 8-month follow-up, the patient showed an uneventful postoperative recovery. A comprehensive literature review was also conducted, and a total of 70 GSF cases were identified and summarized. According to the literature review, patients with GSF generally have a history of head trauma in their childhood, and delayed diagnosis is a common situation. Diagnosis of GSF should include complete retrospective medical history, physical, and imaging examinations. Once the diagnosis is confirmed, cranioplasty accompanied with duroplasty might be the most effective way to relieve symptoms and prevent further damage.
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Affiliation(s)
- Xiao-Hong Yan
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Ke Qiu
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yan Gao
- Department of Oto-Rhino-Laryngology, Chengdu Shangjin Nanfu Hospital, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wendu Pang
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yao Song
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wen Yang
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Rong Yu
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, 34753West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
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Northam W, Chandran A, Quinsey C, Abumoussa A, Flores A, Elton S. Pediatric nonoperative skull fractures: delayed complications and factors associated with clinic and imaging utilization. J Neurosurg Pediatr 2019; 24:489-497. [PMID: 31470399 DOI: 10.3171/2019.5.peds18739] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Skull fractures represent a common source of morbidity in the pediatric trauma population. This study characterizes the type of follow-up that these patients receive and discusses predictive factors for follow-up. METHODS The authors reviewed cases of nonoperative pediatric skull fractures at a single academic hospital between 2007 and 2017. Clinical patient and radiological fractures were recorded. Recommended neurosurgical follow-up, follow-up appointments, imaging studies, and fracture-related complications were recorded. Statistical analyses were performed to identify predictors for outpatient follow-up and imaging. RESULTS The study included 414 patients, whose mean age was 5.2 years; 37.2% were female, and the median length of stay was 1 day (IQR 0.9-4 days). During 438 clinic visits and a median follow-up period of 8 weeks (IQR 4-12, range 1-144 weeks), 231 imaging studies were obtained, mostly head CT scans (55%). A total of 283 patients were given recommendations to attend follow-up in the clinic, and 86% were seen. Only 12 complications were detected, including 7 growing skull fractures, 2 traumatic encephaloceles, and 3 cases of hearing loss. Primary care physician (PCP) status and insurance status were associated with a recommendation of follow-up, actual follow-up compliance, and the decision to order outpatient imaging in patients both with and without intracranial hemorrhage. PCP status remained an independent predictor in each of these analyses. Follow-up compliance was not associated with a patient's distance from home. Among patients without intracranial hemorrhage, a follow-up recommendation and actual follow-up compliance were associated with pneumocephalus and other polytraumatic injuries, and outpatient imaging was associated with a bilateral fracture. No complications were found in patients with linear fractures above the skull base in those without an intracranial hemorrhage. CONCLUSIONS Pediatric nonoperative skull fractures drive a large expenditure of clinic and imaging resources to detect a relatively small profile of complications. Understanding the factors underlying the decision for clinic follow-up and additional imaging can decrease future costs, resource utilization, and radiation exposure. Factors related to injury severity and socioeconomic indicators were associated with outpatient imaging, the decision to follow up patients in the clinic, and patients' subsequent attendance. Socioeconomic status (PCP and insurance) may affect access to appropriate neurosurgical follow-up and deserves future research attention. Patients with no intracranial hemorrhage and with a linear fracture above the skull base do not appear to be at risk for delayed complications and could be candidates for reduced follow-up and imaging.
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Affiliation(s)
| | - Avinash Chandran
- 2Matthew Gfeller Sport-Related TBI Research Center, Department of Exercise and Sport Science; and
| | | | | | - Alex Flores
- 3School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Gurjar HK, Mishra S, Garg K. Incipient Transcalvarial Cerebral Herniation: Underrecognized Complication of Elective Craniotomy. World Neurosurg 2019; 130:240-243. [PMID: 31295622 DOI: 10.1016/j.wneu.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Herniation of the brain through an osseodural defect has been well described in small children as an uncommon occurrence after closed head injury. Pressure from the growing brain has been implicated in progressive enlargement and reshaping of the fracture line. An analogous phenomenon in adults has been observed in the described cases where neurosurgical intervention led to a persistent dural defect. Transcalvarial herniation of the brain through the dural defect resulted in characteristic neurologic and imaging findings producing symptoms disproportionately greater than expected from the extent of the affected brain, accompanied by enlargement of the underlying ventricle and elevation of the bone flap. Disruption of the axonal conduction due to distortion of the axons in the herniated brain is probably responsible for these observations. CASE DESCRIPTION A series of 3 cases is described. In all cases, the dural reconstitution at the conclusion of surgery was incomplete. Brain herniation was evident in the postoperative scan. The transcalvarial herniation of the brain was precipitated by either a seizure and resultant brain swelling or persistently raised intracranial tension from a tumor residual. In 2 cases, surgical reexploration resulted in improvement in the neurologic symptoms. CONCLUSIONS In symptomatic patients with transcalvarial herniation of the brain, identified on imaging, the neurologic syndrome is quite characteristic. Recognition of this condition and prompt treatment lead to lasting neurologic improvement.
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Affiliation(s)
- Hitesh Kumar Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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14
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Cheyuo C, Singh R, Lucke-Wold B, Serrano C. Growing Skull Fracture: Case Report after Rottweiler Bite and Review of the Literature. JOURNAL OF NEUROLOGY & NEUROPHYSIOLOGY 2018; 9. [PMID: 29888100 DOI: 10.4172/2155-9562.1000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Growing skull fracture remains a rare but clinically significant complication of traumatic skull fractures in children less than 3 years of age. Dog attacks on children commonly cause head and neck injuries. We report the first case of growing skull fracture caused by a Rottweiler bite in a 21 days old neonate. Early diagnosis and surgical repair resulted in excellent outcome.
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Affiliation(s)
- Cletus Cheyuo
- Department of Neurosurgery, Ruby Memorial Hospital, West Virginia University, USA
| | - Rahul Singh
- Department of Neurosurgery, Ruby Memorial Hospital, West Virginia University, USA
| | | | - Cesar Serrano
- Department of Neurosurgery, Ruby Memorial Hospital, West Virginia University, USA
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Parri N, Crosby BJ, Mills L, Soucy Z, Musolino AM, Da Dalt L, Cirilli A, Grisotto L, Kuppermann N. Point-of-Care Ultrasound for the Diagnosis of Skull Fractures in Children Younger Than Two Years of Age. J Pediatr 2018; 196:230-236.e2. [PMID: 29499992 DOI: 10.1016/j.jpeds.2017.12.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/30/2017] [Accepted: 12/19/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine the accuracy of skull point-of-care ultrasound (POCUS) for identifying fractures in children younger than 2 years of age with signs of head trauma, and the ability of POCUS to identify the type and depth of fracture depression. STUDY DESIGN This was a multicenter, prospective, observational study of children younger than 2 years of age with nontrivial mechanisms of injury and signs of scalp/skull trauma. Patients were enrolled if they underwent computed tomography (CT). Patients underwent clinical evaluation, in addition to a cranial POCUS in the emergency department (ED). From the POCUS examinations, we documented whether fractures were present or absent, their location, characteristics, and depth. POCUS and CT findings were compared to calculate the diagnostic accuracy. RESULTS We enrolled a convenience sample of 115 of 151 (76.1%) eligible patients. Of the 115 enrolled, 88 (76.5%) had skull fractures. POCUS had a sensitivity of 80 of 88 (90.9%; 95% CI 82.9-96.0) and a specificity of 23 of 27 (85.2%; 95% CI 66.3-95.8) for identifying skull fractures. Agreement between POCUS and CT to identify the type of fracture as linear, depressed, or complex was 84.4% (97 of 115) with a kappa of 0.75 (95% CI 0.70-0.84). CONCLUSIONS POCUS performed by emergency physicians may identify the type and depth of fractures in infants with local physical signs of head trauma with substantial accuracy. Emergency physicians should consider POCUS as an adjunct to clinical evaluation and prediction rules for traumatic brain injuries in children younger than 2 years of age.
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Affiliation(s)
- Niccolò Parri
- Department of Pediatric Emergency Medicine and Trauma Center, Meyer Children's Hospital, Firenze, Italy.
| | - Bradley J Crosby
- Emergency Department, Dixie Regional Medical Center, St. George, UT
| | - Lisa Mills
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Zachary Soucy
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Anna Maria Musolino
- Emergency Department, Bambino Gesù Children's Hospital, IRCCS Rome, Rome, Italy
| | - Liviana Da Dalt
- Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Angela Cirilli
- Department of Emergency Medicine, Long Island Jewish Medical Center & Cohen Children's Medical Center, New Hyde Park, NY
| | - Laura Grisotto
- Department of Statistics G. Parenti, University of Florence and ISPO Cancer Prevention and Research Institute, Florence, Italy
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA; Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, CA
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Figaji AA. Anatomical and Physiological Differences between Children and Adults Relevant to Traumatic Brain Injury and the Implications for Clinical Assessment and Care. Front Neurol 2017; 8:685. [PMID: 29312119 PMCID: PMC5735372 DOI: 10.3389/fneur.2017.00685] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023] Open
Abstract
General and central nervous system anatomy and physiology in children is different to that of adults and this is relevant to traumatic brain injury (TBI) and spinal cord injury. The controversies and uncertainties in adult neurotrauma are magnified by these differences, the lack of normative data for children, the scarcity of pediatric studies, and inappropriate generalization from adult studies. Cerebral metabolism develops rapidly in the early years, driven by cortical development, synaptogenesis, and rapid myelination, followed by equally dramatic changes in baseline and stimulated cerebral blood flow. Therefore, adult values for cerebral hemodynamics do not apply to children, and children cannot be easily approached as a homogenous group, especially given the marked changes between birth and age 8. Their cranial and spinal anatomy undergoes many changes, from the presence and disappearance of the fontanels, the presence and closure of cranial sutures, the thickness and pliability of the cranium, anatomy of the vertebra, and the maturity of the cervical ligaments and muscles. Moreover, their systemic anatomy changes over time. The head is relatively large in young children, the airway is easily compromised, the chest is poorly protected, the abdominal organs are large. Physiology changes—blood volume is small by comparison, hypothermia develops easily, intracranial pressure (ICP) is lower, and blood pressure normograms are considerably different at different ages, with potentially important implications for cerebral perfusion pressure (CPP) thresholds. Mechanisms and pathologies also differ—diffuse injuries are common in accidental injury, and growing fractures, non-accidental injury and spinal cord injury without radiographic abnormality are unique to the pediatric population. Despite these clear differences and the vulnerability of children, the amount of pediatric-specific data in TBI is surprisingly weak. There are no robust guidelines for even basics aspects of care in children, such as ICP and CPP management. This is particularly alarming given that TBI is a leading cause of death in children. To address this, there is an urgent need for pediatric-specific clinical research. If this goal is to be achieved, any clinician or researcher interested in pediatric neurotrauma must be familiar with its unique pathophysiological characteristics.
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Affiliation(s)
- Anthony A Figaji
- Neuroscience Institute, Division of Neurosurgery, University of Cape Town, Red Cross Children's Hospital, Rondebosch, Cape Town, South Africa
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Araki T, Yokota H, Morita A. Pediatric Traumatic Brain Injury: Characteristic Features, Diagnosis, and Management. Neurol Med Chir (Tokyo) 2017; 57:82-93. [PMID: 28111406 PMCID: PMC5341344 DOI: 10.2176/nmc.ra.2016-0191] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Traumatic brain injury (TBI) is the leading cause of death and disability in children. Pediatric TBI is associated with several distinctive characteristics that differ from adults and are attributable to age-related anatomical and physiological differences, pattern of injuries based on the physical ability of the child, and difficulty in neurological evaluation in children. Evidence suggests that children exhibit a specific pathological response to TBI with distinct accompanying neurological symptoms, and considerable efforts have been made to elucidate their pathophysiology. In addition, recent technical advances in diagnostic imaging of pediatric TBI has facilitated accurate diagnosis, appropriate treatment, prevention of complications, and helped predict long-term outcomes. Here a review of recent studies relevant to important issues in pediatric TBI is presented, and recent specific topics are also discussed. This review provides important updates on the pathophysiology, diagnosis, and age-appropriate acute management of pediatric TBI.
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Affiliation(s)
- Takashi Araki
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital
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Sharma R, Gupta P, Mahajan M, Sharma P, Gupta A, Khurana A. Giant nontraumatic intradiploic arachnoid cyst in a young male. Radiol Bras 2016; 49:337-339. [PMID: 27818549 PMCID: PMC5094824 DOI: 10.1590/0100-3984.2013.0022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intradiploic arachnoid cysts have scarcely been reported in the literature, most
reported cases being secondary to trauma. Nontraumatic arachnoid cysts are quite
rare and have been reported mostly in adults. Here, we report the case of a
16-year-old male presenting with a slowly growing mass in the occipital region
and intermittent headaches. On the basis of the findings of X-rays, computed
tomography scans, and magnetic resonance imaging scans of the head, the mass was
diagnosed as a giant intradiploic arachnoid cyst.
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Affiliation(s)
- Rajesh Sharma
- MD, Department of Radiodiagnosis and Imaging, ASCOMS Hospital, Sidhra, Jammu (J&K), India
| | - Puneet Gupta
- MD, Department of Radiodiagnosis and Imaging, Lady Hardinge Medical College, New Delhi, India
| | - Manik Mahajan
- MD, Department of Radiodiagnosis and Imaging, Lady Hardinge Medical College, New Delhi, India
| | - Poonam Sharma
- MD, Department of Pathology, GMC, Jammu (J&K), India
| | - Anchal Gupta
- MD, Department of Radiodiagnosis and Imaging, GMC, Jammu (J&K), India
| | - Arti Khurana
- MD, Department of Radiodiagnosis and Imaging, GMC, Jammu (J&K), India
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Delayed surgical repair of cranial burst fracture without strict dura closure: a prudent choice in selected patients? Childs Nerv Syst 2016; 32:1661-7. [PMID: 27406555 DOI: 10.1007/s00381-016-3155-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Surgical management of cranial burst fracture (CBF) usually involves craniotomy to remove the devitalized brain tissues, followed by watertight repair of dural tears. However, there were times when the dural tear was so extensive that a substantially large bone flap would have to be removed in order to expose the retracted dural margins before it could be repaired. In such cases, strict dural repair would incur a significantly higher risk of damages to the surrounding neural tissues and severe bleeding, especially when the fracture was in the vicinity of eloquent cortical areas and sinus. Basing on our own clinical experiences, we suggest strict dural closure is not mandatory for these selected patients. METHODS A retrospective review of patients who underwent cranial surgery for CBF at our hospital was performed. Computed tomography (CT) and magnetic resonance imaging (MRI) scans were performed to evaluate the extent of dural and brain laceration and the existence of extra-cranial cerebral tissues. Routine craniotomy was delivered to remove the lacerated brain tissues and evacuate the hematoma. The dural defect was only partially fixed with patient's own tissues or artificial dura patch. Then the fractured bone flaps were restored using titanium micro plates and screws. Data including preoperative neurological status, surgery related complications, postoperative cranial fracture healing, and clinical outcomes were obtained through clinical and radiological examinations. RESULTS From October 2004 to March 2013, a total of four patients diagnosed with CBF were treated by this dural closure sparing technique. Their average age was 18.4 months old and the average area of the skull defects was 91 cm(2), with an average interval between primary injury and surgery of 13 days. The diagnosis of CBF was confirmed by intraoperative findings like extrusion of cerebral tissues out of the lacerated dura mater and skull defects. The postoperative courses were uneventful and all patients' neurological functions improved after surgery. Postoperative three dimensional CT reconstruction of the cranial vault showed the skull fractures healed properly in all patients. No patient developed posttraumatic cerebrospinal fluid leak or epilepsy during the on average 24-month follow-up period. CONCLUSIONS In those selected cases of CBF in whom an extraordinary large craniotomy would be required to expose the entire retracted dura margins, given satisfactory evacuation of devitalized brain tissues and restoration of the bone flaps were achieved, we suggest strict dura closure is not compulsory.
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Reuveni-Salzman A, Rosenthal G, Poznanski O, Shoshan Y, Benifla M. Evaluation of the necessity of hospitalization in children with an isolated linear skull fracture (ISF). Childs Nerv Syst 2016; 32:1669-74. [PMID: 27444293 DOI: 10.1007/s00381-016-3175-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/04/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The prevalence of skull fractures after mild head trauma is 2 % in children of all ages and 11 % in children younger than 2 years. The current standard management for a child diagnosed with an isolated skull fracture (ISF), in our institute, is hospitalization for a 24-h observation period. Based on data from the literature, less than 1 % of all minor head injuries require neurosurgical intervention. The main objective of this study was to evaluate the risk of neurological deterioration of ISF cases, in order to assess the need for hospitalization. METHODS We reviewed the medical charts of 222 children who were hospitalized from 2006 to 2012 with ISF and Glascow Coma Scale-15 at the time of arrival. We collected data regarding demographic characteristics, mechanism of injury, fracture location, clinical symptoms and signs, need for hospitalization, and need for repeated imaging. Data was collected at three time points: at presentation to the emergency room, during hospitalization, and 1 month after admission, when the patients' parents were asked about the course of the month following discharge. RESULTS None of the 222 children included in the study needed neurosurgical intervention. All were asymptomatic 1 month after the injury. Two children underwent repeated head CT due to persistence or worsening of symptoms; these CT scans did not reveal any new findings and did not lead to any intervention whatsoever. CONCLUSION Children arriving at the emergency room with a minor head injury and isolated skull fracture on imaging studies may be considered for discharge after a short period of observation. Discharge should be considered in these cases provided the child has a reliable social environment and responsible caregivers who are able to return to the hospital if necessary. Hospital admission should be reserved for children with neurologic deficits, persistent symptoms, suspected child abuse, or when the parent is unreliable or is unable to return to the hospital if necessary. Reducing unnecessary hospitalizations can prevent emotional stress, in addition to saving costs for the child's family and the health care system.
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Affiliation(s)
- Adi Reuveni-Salzman
- The Neurosurgical Pediatric Unit and the Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Guy Rosenthal
- The Neurosurgical Pediatric Unit and the Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Oded Poznanski
- The Neurosurgical Pediatric Unit and the Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Yigal Shoshan
- The Neurosurgical Pediatric Unit and the Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel
| | - Mony Benifla
- The Neurosurgical Pediatric Unit and the Neurosurgery Department, Hadassah Ein Kerem Medical Center, Jerusalem, Israel.
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Naran S, MacIsaac Z, Katzel E, Bykowski M, Shakir S, Goldstein J, Pollack IM, Losee JE. Pediatric Craniofacial Fractures: Trajectories and Ramifications. J Craniofac Surg 2016; 27:1535-8. [PMID: 27391657 DOI: 10.1097/scs.0000000000002837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The pediatric craniofacial skeleton fractures in patterns distinct from those typical in adults; this has implications pertinent to management that may go unrecognized. The authors reviewed multilevel pediatric craniofacial fractures presenting to their institution, surmising that they would display an oblique trajectory of fracture patterns, and would be at increased risk of growing skull fractures (GSFs), compared with adults. METHODS A retrospective review was performed of pediatric patients presenting with multilevel craniofacial fractures between 2004 and 2010. Demographics, cause of injury, fracture patterns, associated injuries, management, and follow-up information were gathered. Computed tomography scans were reviewed to characterize fracture length, displacement, and trajectory. Adverse outcomes were documented, with particular attention to GSFs. RESULTS One hundred fifty-one patients met our inclusion criteria, which included a follow-up of >3 years. Average age at injury was 9.5 ± 4.7 years. Patterns of fracture displayed near consistent obliquity, with only 4 patients (2.6%) displaying a LeFort-type facial fracture. LeFort patterns were associated with older patients over the age of 12, but without statistical significance (P = 0.07). Five patients (3.3%) died as a result of their injuries. 3.3% of patients developed a GSF. All craniofacial fracture patients demonstrated radiographic and/or clinical evidence of healed fractures at their last follow-up. CONCLUSIONS This series of pediatric craniofacial fractures near consistently demonstrated oblique fracture patterns, in contrast to the typical adult fracture patterns described by LeFort. Pediatric craniofacial fractures are also at increased risk of GSFs. Understanding of these principles is fundamental to successful therapy in this population.
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Affiliation(s)
- Sanjay Naran
- *Department of Plastic Surgery, University of Pittsburgh, Pittsburgh †Division of Plastic Surgery, University of Pennsylvania, Philadelphia ‡Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA
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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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Huang KT, Abd-El-Barr MM, Dunn IF. Skull Fractures and Structural Brain Injuries. HEAD AND NECK INJURIES IN YOUNG ATHLETES 2016:85-103. [DOI: 10.1007/978-3-319-23549-3_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Abstract
Despite advances in the acute management of craniofacial fractures, some patients will present with secondary deformities. In an attempt to formulate treatment guidelines, we present a review of 152 cases of post-traumatic craniofacial deformities treated by us using different surgical techniques. Analysis of the underlying bony and soft tissue deficits was followed by stepwise reassembly of the skeletal fragments and re-establishment of facial contour and symmetry. The postoperative outcomes were evaluated in terms of aesthetic and functional parameters. Though all patients had considerable improvement after secondary correction of these deformities, soft tissue deficits and time elapsed till secondary reconstruction remain the major factors in achieving an ideal aesthetic outcome.
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Bir SC, Kalakoti P, Notarianni C, Nanda A. John Howship (1781-1841) and growing skull fracture: historical perspective. J Neurosurg Pediatr 2015; 16:472-6. [PMID: 26186359 DOI: 10.3171/2014.12.peds14484] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In the late 18th and early 19th centuries, Dr. John Howship, a pioneering British surgeon, described the clinical features and pathophysiology of various surgical disorders of the human body. His critical contributions to pediatric neurosurgery came in 1816 when he first described the features of an important childhood condition following head trauma, what he referred to as parietal bone absorption. This condition as depicted by Dr. Howship was soon to be christened by later scholars as traumatic cephalhydrocele, traumatic meningocele, leptomeningeal cyst, meningocele spuria, fibrosing osteitis, cerebrocranial erosion, and growing skull fracture. Nevertheless, the basic features of the condition as observed by Dr. Howship were virtually identical to the characteristics of the above-mentioned disorders. This article describes the life and accomplishments of Dr. Howship and his contributions to the current understanding of growing skull fracture.
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Affiliation(s)
- Shyamal C Bir
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | - Piyush Kalakoti
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
| | | | - Anil Nanda
- Department of Neurosurgery, LSU Health Shreveport, Louisiana
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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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Gandhoke GS, Hauptman JS, Salvetti DJ, Weiner GM, Panigrahy A, Yilmaz S, Pollack IF. Transosseous cerebrospinal fluid fistula 14 years after Chiari decompression: presentation and management. J Neurosurg Pediatr 2015; 16:146-9. [PMID: 25978535 DOI: 10.3171/2015.1.peds14575] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a unique case of a transosseous CSF fistula that was detected more than 10 years after treatment of a symptomatic Chiari I malformation. This lesion initially presented as an intraosseous cystic lesion involving the C-2 vertebra, which was found to communicate freely with the subarachnoid space through a tiny dural opening. Surgical management involved hemilaminectomy and repair of the dural defect followed by reinforcement of the bony defect with demineralized bone matrix. Following closure of the fistula, symptoms of elevated intracranial pressure developed, necessitating a ventriculoperitoneal shunt for CSF diversion.
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Affiliation(s)
| | | | | | | | | | - Sabri Yilmaz
- Radiology, Children's Hospital of Pittsburgh, Pennsylvania
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Abstract
BACKGROUND Delayed swelling after skull fractures is an uncommon complication following head trauma in children. Classically, growing skull fractures typically present in patients under 3 years of age with progressive subcutaneous fluid collections, or occasionally with neurologic symptoms. We present the case of a healthy 2-year-old boy with a lytic "punched-out" frontal skull lesion. The child presented 2 months after a minor forehead injury for which no medical attention was sought. METHODS The skull defect had no associated leptomeningeal cyst or brain herniation. Imaging and presentation were thought to be consistent with eosinophilic granuloma. Histologic findings demonstrated a healing skull fracture. RESULTS Cranioplasty was performed, and the patient had an uncomplicated postoperative course. CONCLUSIONS In this report, we describe our experience with this atypical presentation of a healing skull fracture mimicking a typical eosinophilic granuloma.
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Prasad GL, Gupta DK, Mahapatra AK, Borkar SA, Sharma BS. Surgical results of growing skull fractures in children: a single centre study of 43 cases. Childs Nerv Syst 2015; 31:269-77. [PMID: 25227164 DOI: 10.1007/s00381-014-2529-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Growing skull fractures are rare complications of traumatic skull fractures in children. The authors aim to share their experience in management of such lesions and analyse clinicoradiological features, surgical management and outcome in addition to prognostication factors. MATERIALS AND METHODS Retrospective study performed to include patients ≤18 years operated for growing skull fractures at our trauma centre from December 2007 to February 2014. RESULTS Forty-three children were operated. Mean age at presentation was 4.57 years (range 7 months-18 years). Mean duration of onset of symptoms from initial trauma was 3.34 months (2 days-24 months). Mean interval from symptom onset to surgical repair was 11.6 months (1 week-15 years). Progressive non-tender scalp swelling was the most common symptom and parietal, the most common location. Duraplasty alone was performed in four patients while combined duro-cranioplasty was performed in the rest. Mean follow-up duration was 31 months (4-72 months). Subdural hygroma was associated in six cases. Two patients expired; rest all survivors had good-to-excellent cosmetic outcomes. CONCLUSIONS Being the second largest series to date, it adds significant valuable contribution to this topic. Poor prognostic factors were age >8 years, females, large defects (>7 cm), severe head injury at initial trauma, defects crossing midline and delayed repair (>8 months). Delayed onset seizures and new onset/progression of pre-existing deficits can be indirect markers of evolution. Surgical repair with water-tight dural closure is the standard treatment. Emphasis on early treatment is highlighted which is probably beneficial in improving neurological deficits. Good-to-excellent outcomes are noted in majority, even in cases with delayed presentations.
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Affiliation(s)
- G Lakshmi Prasad
- Department of Neurosurgery, JPNATC, All India Institute of Medical Sciences, New Delhi, India
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Collins J, Gosman AA, Meltzer HS. Growing skull fracture of midline posterior cranial vault. J Pediatr 2015; 166:494. [PMID: 25454312 DOI: 10.1016/j.jpeds.2014.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 10/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Collins
- Oasis MD, San Diego, California; Department of Surgery (Health Sciences), University of California San Diego, Rady Children's Hospital, San Diego, California
| | - Amanda A Gosman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Diego, San Diego, California
| | - Hal S Meltzer
- Division of Neurosurgery, Department of Surgery, University of California San Diego Medical Center, Pediatric Neurosurgery, Rady Children's Hospital, San Diego, California
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Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog. Case Rep Vet Med 2015. [DOI: 10.1155/2015/372608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 2-year-old female spayed Miniature Dachshund was presented for seizures and right prosencephalic signs. A multiloculated, ring-enhancing mass in the right cerebrum associated with dilation of the right lateral ventricle and brain herniation was seen on magnetic resonance imaging. An irregular calvarial defect with smoothly scalloped edges was seen overlying the mass on computed tomography. The mass was removed via craniectomy and was diagnosed as a chronic brain abscess caused byPeptostreptococcus anaerobius. The patient was maintained on antibiotics for 12 weeks. Follow-up MRI performed 14 weeks after surgery confirmed complete removal of the abscess as well as a contrast-enhancing collection of extra-axial material consistent with a chronic subdural hematoma. The neurologic abnormalities, including seizures, have improved in the 44 months since surgery. Brain abscesses in dogs can have an insidious clinical course prior to causing serious neurologic deterioration. Ventricular entrapment by an intracranial mass can contribute to acute neurologic decline. If surgically accessible, outcome following removal of a brain abscess can be excellent; aerobic and anaerobic bacterial culture should be performed in these cases. Subdural hematoma can occur following removal of a large intracranial mass. Growing skull fractures can occur in dogs but may not require specific surgical considerations.
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While B, Saha K, Radford R, Thorne J, Leatherbarrow B. A reliable surgical technique for the management of growing fractures of the frontal bone involving the orbit. Orbit 2013; 32:166-70. [PMID: 23617683 DOI: 10.3109/01676830.2013.774026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Growing fractures involving the orbit occur infrequently. Due to the risk of neurological trauma and the ophthalmic sequelae of progressive intraorbital expansion of the fracture, surgical management is indicated. There is no accepted standard in the approach to the surgical management of these patients. The aim of this paper is to describe a reliable technique for the repair of growing fractures and discuss the long-term outcome. METHODS We present two cases in which a technique using Norian CRS® (Craniofacial Repair System) fast set putty over a Medpor® scaffold was used to repair a growing fracture. RESULTS This technique provides a secure repair with a good functional and cosmetic outcome. CONCLUSIONS Growing fractures occur in the paediatric population so it is important to ensure that the repair does not restrict or adversely affect future bone growth. One case has been followed-up for over 10 years and has maintained normal growth.
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Affiliation(s)
- Benjamin While
- Manchester Royal Eye Hospital, Ophthalmology, Manchester, United Kingdom.
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Sahoo N, Kumar P, Rappai T. Growing skull fracture. Indian J Dent 2013. [DOI: 10.1016/j.ijd.2012.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Growing skull fractures after craniosynostosis repair: risk factors and treatment algorithm. J Craniofac Surg 2012; 23:1292-5. [PMID: 22948644 DOI: 10.1097/scs.0b013e31825435d5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Growing skull fractures (GSFs) are rare complications after severe head injuries in the early childhood and rarely occur after craniosynostosis repair. The aim of this study was to define an algorithm for sufficient treatment for GSF after craniofacial procedures. Literature research was performed to clarify risk factors for GSFs after cranial vault reshaping. Conclusions of the literature and experiences of the authors based on a case of GSF after craniofacial surgery were matched to establish guidelines for successful therapy.
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Abstract
Head injuries in children are common, comprising more than half of all injuries sustained. The mortality and morbidity associated with traumatic head injury in children is staggering, and the cumulative effect of such on the pediatric and general populations is propagated through related health care measures and subsequent socioeconomic burden. The majority of deaths due to trauma in children are caused by brain injury. This article reviews the evaluation and management of scalp injuries in the pediatric patient. The second portion addresses skull fractures, the specter of child abuse, management of acute fracture, and the phenomenon of growing skull fractures.
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Affiliation(s)
- Bruce B Horswell
- Charleston Area Medical Center, 830 Pennsylvania Avenue, Suite 302, Charleston, WV 25302, USA.
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Abstract
OBJECT A growing skull fracture (GSF) is a rare but significant late complication of skull fractures, usually occurring during infancy and early childhood. Delayed diagnosis and improper treatment could exacerbate this disease. The aim of this study was to introduce a new hypothesis about, describe the stages of, and discuss the treatment strategy for GSF. METHODS The authors performed a retrospective review of 27 patients with GSF, who were grouped according to 3 different GSF stages. RESULTS Over a period of 20 years, 27 patients with GSF (16 males and 11 females) were treated in the authors' department. The mean follow-up period was 26.5 months. Six patients were in the prephase of GSF (Stage 1), 10 patients in the early phase (Stage 2), and 11 in the late phase (Stage 3). All patients underwent duraplasty. All 6 patients at Stage 1 and 5 patients at Stage 2 underwent craniotomy without cranioplasty. Five patients at Stage 2 and all of the patients at Stage 3 underwent cranioplasty with autologous bone and alloplastic materials, respectively. Among all patients, 5 underwent ventriculoperitoneal shunt placement. Symptoms in all patients at Stages 1 and 2 were alleviated or disappeared, and the cranial bones developed without deformity during follow-up. Among patients with Stage 3 GSF, no obvious improvement in neurological deficits was observed. Three patients underwent additional operations because of cranial deformation or infection. CONCLUSIONS The authors identify the stages of GSF according to a new hypothesis. They conclude that accurately diagnosing and treating GSF during Stages 1 and 2 leads to a better prognosis.
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Affiliation(s)
- Xue-Song Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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Pinto PS, Meoded A, Poretti A, Tekes A, Huisman TAGM. The unique features of traumatic brain injury in children. review of the characteristics of the pediatric skull and brain, mechanisms of trauma, patterns of injury, complications, and their imaging findings--part 2. J Neuroimaging 2012; 22:e18-41. [PMID: 22303964 DOI: 10.1111/j.1552-6569.2011.00690.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children. The unique biomechanical, hemodynamical, and functional characteristics of the developing brain and the age-dependent variance in trauma mechanisms result in a wide range of age specific traumas and patterns of brain injuries. Detailed knowledge of the main primary and secondary pediatric injuries, which enhance sensitivity and specificity of diagnosis, will guide therapy and may give important information about the prognosis. In recent years, anatomical but also functional imaging methods have revolutionized neuroimaging of pediatric TBI. The purpose of this article is (1) to comprehensively review frequent primary and secondary brain injuries and (2) to give a short overview of two special types of pediatric TBI: birth related and nonaccidental injuries.
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Affiliation(s)
- Pedro S Pinto
- Division of Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital, Baltimore, MD, USA
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Head and Spinal Cord Injury: Diagnosis and Management. Neurol Clin 2012; 30:241-76, ix. [DOI: 10.1016/j.ncl.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Chauvet D, Sainte-Rose C, Boch AL. [The mystery of prehistoric trepanations: Is neurosurgery the world eldest profession?]. Neurochirurgie 2010; 56:420-5. [PMID: 20869089 DOI: 10.1016/j.neuchi.2010.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
Abstract
Trepanation is known to be the first surgical procedure ever performed. Its origins date from the Neolithic Age in Europe and the operation was particularly performed in South America at the Pre-Colombian era, a few thousand years later. Based on many archeological studies on trepanned skulls, we compare the differences and similarities of these two periods through epidemiological, topographical, and technical approaches. Signs of bony regeneration are assessed in an attempt to understand the postoperative survival of trepanned patients. The literature in surgery and archeology does not mention the possible relation between trepanations and growing skull fractures. However, it is reasonable to think that these cranial holes, occurring after a pediatric skull fracture, could mimic real trepanation orifices. The possible connections between these two entities are discussed. The etiological hypotheses on prehistoric trepanation are reviewed.
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Affiliation(s)
- D Chauvet
- Service de neurochirurgie, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Abstract
The author describes 2 cases of children with growing skull fractures (GSFs). Surgical exploration of the widened fracture shortly after the head injury failed to reveal a dural tear because the neuroimaging studies (MR images, CT scans, and skull radiographs) had not been accurately interpreted, thereby allowing the development of a GSF at the site of the actual dural injury. In both cases, the dural and bony defect and the leptomeningeal cyst were successfully repaired. To prevent GSFs associated with progressive neurological deficit, seizure, ventricular porencephaly, and encephalomalacia, the author surgically explores wide skull fractures in young children with head injury whose MR images demonstrate brain herniation through the dura mater. The importance of a brief delay in surgical exploration is emphasized to allow cerebral edema to resolve and the patient's condition to become medically stabilized.
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Affiliation(s)
- Robert A Sanford
- Department of Pediatric Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Clinic, Memphis, Tennessee 38120, USA.
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Meier JD, Dublin AB, Strong EB. Leptomeningeal cyst of the orbital roof in an adult: case report and literature review. Skull Base 2009; 19:231-5. [PMID: 19881904 DOI: 10.1055/s-0028-1096206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To present the case of a leptomeningeal cyst involving the orbital roof in an adult. DESIGN Case report and literature review. SETTING Tertiary referral center. SUMMARY A 47-year-old female with a remote history of a skull fracture at 3 years of age presented with increasing headaches and retro-orbital pain. A computed tomogram and magnetic resonance image revealed a leptomeningeal cyst of the orbital roof. RESULTS Only one previous leptomeningeal cyst of the orbital roof has been reported in an adult. Surgical excision of the lesion was performed and follow-up imaging 18 months after the operation revealed no evidence of recurrence. CONCLUSION Although extremely rare, adult patients can develop growing skull fractures or leptomeningeal cysts of the orbital roof. Such lesions should be included in the differential diagnosis when a patient presents with orbital pain or exophthalmos and a history of head trauma as a child.
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Affiliation(s)
- Jeremy D Meier
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis Medical Center, Sacramento, CA
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Reconstruction of growing skull fracture with in situ galeal graft duraplasty and porous polyethylene sheet. J Craniofac Surg 2009; 20:1245-9. [PMID: 19553832 DOI: 10.1097/scs.0b013e3181acdfaf] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE In growing skull fractures with large calvarial defects, it is difficult to use autografts for reconstruction and it requires alternative materials for cranioplasty. In this report, the authors describe their experience and introduce reconstruction of the growing skull fractures' defects with a porous polyethylene sheet (Medpor) and with a novel technique of duraplasty with in situ galeal graft, which avoid the potentially risky dissection and exposure of brain tissue. The goal of this study was to clarify effective surgical methods and to provide the rationale for these techniques. METHODS We performed this technique on 8 patients with large calvarial defects resulting from growing skull fractures. The skin flap was retracted, leaving the galeal plane adherent to the underlying defect. After removing the bony edges and exposing the underlying retracted dural margins, duraplasty was performed by suturing the galeal tissue left in situ on the defect of the dural margins. Bone reconstruction was performed by placing porous polyethylene sheet (Medpor). CONCLUSIONS Duraplasty with in situ galeal tissue is a simple, safe, and effective technique to reconstruct dural defects in growing skull fracture, which avoids the risky dissection of the brain tissue. Also, by using Medpor, growing skull fractures can be effectively reconstructed with good cosmetic results.
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Tang PH, Lim CCT. Imaging of accidental paediatric head trauma. Pediatr Radiol 2009; 39:438-46. [PMID: 19125244 DOI: 10.1007/s00247-008-1083-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 09/21/2008] [Indexed: 10/24/2022]
Abstract
Head trauma is the most common form of injury sustained in serious childhood trauma and remains one of the top three causes of death despite improved road planning and safety laws. CT remains the first-line investigation for paediatric head trauma, although MRI may be more sensitive at picking up the full extent of injuries and may be useful for prognosis. Follow-up imaging should be tailored to answer the specific clinical question and to look for possible complications.
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Affiliation(s)
- Phua Hwee Tang
- Department of Diagnostic Imaging, KK Women's and Children's Hospital, Singapore, Singapore.
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Pediatric Orbital Fractures: Classification, Management, and Early Follow-Up. Plast Reconstr Surg 2008; 122:886-897. [DOI: 10.1097/prs.0b013e3181811e48] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Singhal A, Steinbok P. Operative management of growing skull fractures: a technical note. Childs Nerv Syst 2008; 24:605-7. [PMID: 18157539 DOI: 10.1007/s00381-007-0552-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Indexed: 11/25/2022]
Abstract
OBJECTS Growing skull fractures can be a challenging surgical problem facing the pediatric neurosurgeon. The goal of this manuscript is to clarify effective surgical methods and to provide the rationale for these techniques. METHODS We describe the surgical techniques for treatment of growing skull fractures. We clarify the underlying concepts, with respect to dural closure and repair of bony defects, that have led to these techniques. CONCLUSIONS With effective surgical technique, the pediatric neurosurgeon can effectively treat growing skull fractures, with excellent outcomes in terms of bony coverage and cosmesis.
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Affiliation(s)
- Ashutosh Singhal
- Division of Neurosurgery, Department of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, 4480 Oak Street, Room K3-159, Vancouver, British Columbia, Canada, V6H 3V4.
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Hydroxyapatite Cement Resistant to Fragmentation Following Full Cerebrospinal Fluid Bathing. J Craniofac Surg 2008; 19:283-6. [DOI: 10.1097/scs.0b013e31815ca1a5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Guzel A, Tatli M, Kilincer C, Yilmaz F. Posttraumatic intraventricular arachnoid cyst accompanied by pseudomeningoencephalocele in a child. J Clin Neurosci 2007; 14:1210-3. [PMID: 17884508 DOI: 10.1016/j.jocn.2006.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Revised: 03/31/2006] [Accepted: 04/16/2006] [Indexed: 10/22/2022]
Abstract
Growing skull fracture (GSF) is a rare complication of head trauma. A posttraumatic intraventricular arachnoid cyst (AC), neither isolated nor accompanied by a GSF has not been reported previously. A seven-year-old girl was admitted after a severe head injury with a separated right parieto-occipital fracture and contusion. She responded well to conservative therapy. Seven weeks after discharge, she was re-admitted with a large parieto-occipital pseudomeningoencephalocele due to herniation of cerebrospinal fluid and neural tissue to the subgaleal space through the widened fracture defect, an extra-axial cyst at the posterior interhemispheric space and an intraventricular cystic mass. She underwent open surgery, and the intraventricular cystic mass was totally removed. The histological findings were consistent with an AC. One week after dural repair, hydrocephalus developed, and a ventriculo-peritoneal shunt was inserted. She did well during two-year follow-up. The present case is unique as an intraventricular AC following head trauma. When an intraventricular cystic lesion is encountered after severe head trauma, the possibility of an AC should be considered; especially with neighboring contused neural tissue and leptomeningeal cyst formation.
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Affiliation(s)
- Aslan Guzel
- Department of Neurosurgery, Faculty of Medicine, University of Dicle, 21280 Diyarbakir, Turkey
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Vignes JR, Jeelani NUO, Jeelani A, Dautheribes M, Liguoro D. Growing skull fracture after minor closed-head injury. J Pediatr 2007; 151:316-8. [PMID: 17719947 DOI: 10.1016/j.jpeds.2007.04.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Revised: 02/26/2007] [Accepted: 04/19/2007] [Indexed: 11/20/2022]
Affiliation(s)
- Jean-Rodolphe Vignes
- Department of Neurosurgery A, CHU of Bordeaux, University of Bordeaux 2, Bordeaux, France.
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