Prevention of growing skull fractures: report of 2 cases.
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.
Sanford
Robert A
RA
Department of Pediatric Neurosurgery, University of Tennessee Health Science Center, Semmes-Murphey Clinic, Memphis, Tennessee 38120, USA. Robert.Sanford@stjude.org
D000058:Accidental Falls; D000063:Accidents, Traffic; D001929:Brain Edema / Q000209:etiology / Q000601:surgery; D002540:Cerebral Cortex / Q000293:injuries / Q000601:surgery; D006259:Craniocerebral Trauma / Q000150:complications / Q000601:surgery; D003951:Diagnostic Errors; D004388:Dura Mater / Q000293:injuries; D004677:Encephalocele / Q000209:etiology / Q000601:surgery; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology; D019635:Neurosurgical Procedures; D012887:Skull Fractures / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed