Related Experiment Video
Updated: Mar 23, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Growing skull fractures: guidelines for early diagnosis and surgical management
Ishwar Singh1, Seema Rohilla2, Saquib Azad Siddiqui2
1PT.BD Sharma University of Health Sciences Rohtak, Rohtak, Haryana, India. drishwarsingh@yahoo.co.in.
Insights
Growing skull fracture (GSF) in children is rare but serious. Early diagnosis using specific criteria, including imaging, is key to preventing complications and ensuring good outcomes.
Area of Science:
- Pediatric Neurosurgery
- Trauma Surgery
- Radiology
Background:
- Growing skull fracture (GSF) is a rare pediatric head trauma complication.
- GSF can lead to delayed neurological deficits and cranial defects.
- Early diagnosis and treatment are crucial but lack clear guidelines.
Purpose of the Study:
- To identify diagnostic criteria for early detection of GSF.
- To establish guidelines for managing pediatric head trauma with suspected GSF.
Main Methods:
- Evaluated pediatric head trauma patients with linear fractures (2010-2015).
- Used contrast brain MRI for patients <5 years with cephalhematoma, diastasis ≥4mm, and brain contusion.
- Assessed for dural tear and brain herniation.
Main Results:
- 16 of 20 patients with dural defects and herniation underwent surgery.
- 4 patients without MRI-confirmed dural tear or herniation showed no GSF signs on follow-up.
- Contrast MRI identified high-risk patients for GSF.
Conclusions:
- Early GSF diagnosis relies on age <5 years, cephalhematoma, diastasis ≥4mm, brain contusion, and MRI findings of dural tear/herniation.
- Dural tear with herniation is the primary cause of GSF.
- Prompt diagnosis and surgical intervention improve GSF outcomes.
Background:
Growing skull fracture (GSF) is a rare complication of pediatric head trauma and causes delayed onset neurological deficits and cranial defect. GSF usually develops following linear fracture with underlying dural tear resulting in herniation of the brain. Early diagnosis and treatment are essential to avoid complications. However, there are no clear-cut guidelines for the early diagnosis of GSF. The present study was conducted to identify the criteria for the early diagnosis of GSF.
Material And Methods:
From 2010 to 2015, all pediatric patients of head trauma with linear fracture were evaluated. Patients of age <5 years with cephalhematoma, bone diastasis of 4 mm or more with underlying brain contusion were subjected to contrast brain MRI to find out the dural tear and herniation of the brain matter. Patients with contrast MRI showing dural tear and herniation of the brain matter were considered high risk for the development of GSF and treated surgically within 1 month of trauma. Patients with contrast brain MRI not showing dural tear and herniation of the brain matter were regularly followed for any signs of GSF.
Results:
A total of 20 patients were evaluated, out of which 16 showed dural defects with herniation of the brain matter and were subjected to duraplasty. Four patients in which MRI did not show dural tear and herniation of the brain matter were regularly followed-up and have not shown any sign of GSF later on follow-up.
Conclusion:
Early diagnosis of GSF can be made based on the four criteria, i.e., (1) age <5 year with cephalhematoma, (2) bone diastasis 4 mm or more (3) underlying brain contusion (4) contrast MRI showing dural tear and herniation of the brain matter. Dural tear with herniation of the brain matter is the main etiopathogenic factor for the development of GSF. Early diagnosis and treatment of GSF can yield a good outcome.
Related Concept Videos
01:27Fractures: Bone Repair
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
01:22Sutures of the Skull
Sutures are immobile joints between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the skull bones are not straight but instead follow irregular, tightly twisting paths. These twisting lines tightly...
01:08Overview of the Skull
The cranial vault surrounds and protects the brain and houses the middle and inner ear structures. This cavity is bounded superiorly by the rounded top of the skull, which...