[Growing skullbase fracture--a case report with special reference to its pathogenesis]
Chieko Nagata1, Toshiro Katsuta, Midori Kenjo
1Department of Pediatrics, Kitakyushu Municipal Medical Center, Kokurakita-ku, Kitakyushu 802-0077, Japan.
Insights
A rare growing skull base fracture was identified in a child with a history of meningitis. Early monitoring of fracture lines is crucial for diagnosis and management of this condition.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Radiology
Background:
- Growing skull fractures are rare, particularly in the anterior cranial base.
- Previous skull fractures and meningitis are potential risk factors.
Observation:
- A six-year-old girl presented with bacterial meningoencephalitis.
- Neuroimaging revealed a bone defect and meningocele consistent with a growing skull base fracture.
Findings:
- The case highlights the rarity of anterior skull base growing fractures, affecting both pediatric and adult patients.
- Post-traumatic meningocele/encephalocele may represent the same entity as growing skull base fractures.
- Tissue weakness, in addition to brain growth and dural tears, is a significant factor in fracture progression.
Implications:
- Growing skull base fractures are challenging to diagnose externally.
- Close follow-up of fracture line changes from the initial injury is essential for timely intervention.
Abstract:
This report describes a growing skullbase fracture in a six-year-old girl. She had a history of anterior skullbase fracture three years previously and meningitis two years later. She was referred to our hospital because of bacterial meningoencephalitis. Neuroimaging disclosed a bone defect and meningocele at the same site as the previous fracture. Although a growing skull fracture of the anterior cranial base is extremely rare, the reported cases include not only pediatric patients but also adults. Furthermore, posttraumatic pseudo-meningocele or encephalocele can be considered to be part of the same entity as growing skullbase fracture. Therefore, "weakness of surrounding tissue" seems to be another important factor as well as "the expanding force of the growing brain" and "dural tear", which are well-known to be essential in the growth of a fracture. Since a growing fracture at the anterior skullbase is difficult to identify from the outside, it is very important to follow-up changes in the fracture line from the acute stage of injury.
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