Growing skull fracture stages and treatment strategy.
OBJECTIVE
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.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China. xuesongliu98@gmail.com
Xue-Song
XS
Liu
Chao
C
You
Ma
M
Lu
Jia-Gang
JG
Liu
D016080:Arachnoid Cysts / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*; D002675:Child, Preschool; D003399:Craniotomy; D057210:Delayed Diagnosis; D004388:Dura Mater / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012886:Skull / Q000293:injuries / Q000601:surgery; D012887:Skull Fractures / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D015599:Trauma Severity Indices; D017287:Ventriculoperitoneal Shunt