title: A Review of Techniques Used in the Management of Growing Skull Fractures.
abstract: BACKGROUND
  Growing skull fractures (GSFs) are rare complications of pediatric head trauma that comprise skull fractures associated with an underlying dural tear and an intact arachnoid membrane. They are often misdiagnosed, and delay in management can lead to progression of the disease along with its neurological sequelae. Multiple clinical reports and qualitative reviews on this entity exist. To our knowledge, this represents the largest clinical review reporting on established techniques in the management of these fractures.
  
  
  METHODS
  A literature search was performed on the databases Embase, Medline, Cochrane, and PubMed from their inception until February 2015 using the terms "Growing," "Skull," "Fracture," and their equivalent terms. Studies included were case series with 5 or more patients describing GSFs and their management.
  
  
  RESULTS
  Twenty-two articles reporting 440 patients were included in the analysis. The mean age at trauma was 8.8 months, with the mean at presentation of 21.9 months and 57.8% of the patients being males. Most commonly, a combined dura-cranioplasty was done in 61.6% of the patients. A range of autoplastic and alloplastic materials were used in both of these techniques. Improvement from preoperative clinical status in seizures and neurological deficits was noted in 18 (12.7%) and 11 (7.05%) of the patients, respectively, following operative repair and medical management.
  
  
  CONCLUSIONS
  Early recognition is crucial in the management and treatment of GSF. Children at risk for developing GSF should be monitored clinically for up to 3 months following the initial insult. The surgical treatment depends on the size of the fracture and the age of the patient. A summary of the presentation, management, associated outcomes, complications, and recommendations discussed in the literature are reported within.
authors.affiliation: *Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada†Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: Noemie
authors.initials: N
authors.lastname: Vezina
authors.forename: Becher
authors.initials: B
authors.lastname: Al-Halabi
authors.forename: Hani
authors.initials: H
authors.lastname: Shash
authors.forename: Roy R
authors.initials: RR
authors.lastname: Dudley
authors.forename: Mirko S
authors.initials: MS
authors.lastname: Gilardino
mesh_terms: D006259:Craniocerebral Trauma / Q000150:complications; D003399:Craniotomy / Q000379:methods; D003951:Diagnostic Errors / Q000009:adverse effects / Q000517:prevention & control; D018450:Disease Progression; D004388:Dura Mater / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control*; D019635:Neurosurgical Procedures / Q000379:methods; D012886:Skull / Q000254:growth & development / Q000601:surgery; D012887:Skull Fractures / Q000150:complications / Q000209:etiology / Q000601:surgery