title: Surgical results of growing skull fractures in children: a single centre study of 43 cases.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Department of Neurosurgery, JPNATC, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: G Lakshmi
authors.initials: GL
authors.lastname: Prasad
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Gupta
authors.forename: Ashok Kumar
authors.initials: AK
authors.lastname: Mahapatra
authors.forename: Sachin Anil
authors.initials: SA
authors.lastname: Borkar
authors.forename: Bhawani Shankar
authors.initials: BS
authors.lastname: Sharma
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications; D018450:Disease Progression; D004388:Dura Mater / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012886:Skull / Q000601:surgery; D012887:Skull Fractures / Q000473:pathology* / Q000601:surgery*