The risk of growing skull fractures in craniofacial patients
Sassan Keshavarzi1, Hal Meltzer, Steven R Cohen
1Department of Surgery, Division of Neurosurgery, University of California, San Diego, Calif., USA.
Insights
Growing skull fractures (GSFs) are rare after craniofacial surgery, even with dural tears. Prompt surgical repair minimizes risk, though coronal craniosynostosis may increase susceptibility.
Area of Science:
- Craniofacial Surgery
- Pediatric Neurosurgery
- Surgical Complications
Background:
- Growing skull fractures (GSFs) are uncommon complications following head trauma or craniofacial procedures involving dural tears.
- This study investigates the incidence of GSFs after craniofacial surgery in a single institution.
Purpose of the Study:
- To evaluate the relationship between craniofacial surgery, dural tears, and the subsequent development of GSFs.
- To compare institutional experience with published literature on GSFs post-craniofacial surgery.
Main Methods:
- Retrospective review of 180 craniofacial surgeries (2000-2007) with suspected dural tears.
- Literature review of GSFs occurring after craniofacial surgery.
Main Results:
- Twenty-five of 180 patients experienced operative dural compromise; one developed a pseudomeningocele.
- The literature review identified 12 GSF cases post-craniofacial surgery, with 7 associated with coronal suture fusion.
Conclusions:
- GSF development after craniofacial surgery with dural compromise is unlikely with meticulous intraoperative identification and repair.
- Coronal craniosynostosis may be a risk factor for developing GSFs after craniofacial surgery.
Background/Aims:
Growing skull fractures (GSFs) are unusual sequelae of head injury in young children which have also been reported to occur after craniofacial procedures complicated by inadvertent durotomy. We reviewed the craniofacial experience in a single institution, detailing 180 cases of craniofacial surgery and suspected dural tears and their relationship to the subsequent development of GSFs. This experience was then compared to that of the pertinent published literature.
Methods:
A retrospective review of the senior authors' craniofacial surgical experience from 2000 to 2007 was performed. This was compared to an English-language literature review of GSFs after craniofacial surgery.
Results:
In our institution, 180 cases of craniofacial surgery (83 open, 97 endoscopic) were performed, with an average follow-up of 23.5 months. Twenty-five patients (15 open, 10 endoscopic surgeries) had operative dural compromise. One of these patients developed a persistent pseudomeningocele requiring reoperation. Twelve cases of GSF after craniofacial surgery were identified in a review of the English-language literature, of which 7 (58%) had coronal suture fusion.
Conclusions:
While durotomy may occur during craniofacial surgery, the subsequent development of a GSF appears to be an unlikely event with an aggressive intraoperative approach of identification and repair. Coronal craniosynostosis may confer an increased risk for this complication.
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