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Growing skull fractures: progressive evolution of brain damage and effectiveness of surgical treatment
G B Scarfò1, A Mariottini, D Tomaccini
1Cattedra di Neurochirurgia, Università di Siena, Italy.
Insights
Growing skull fractures in infants result from head injury, dural tears, and rapid brain growth, causing abnormal skull and brain growth. Surgical intervention can yield good results even in late-stage cases.
Area of Science:
- Pediatric Neurosurgery
- Developmental Neurology
- Pediatric Traumatology
Background:
- Growing skull fractures (GSF) are a recognized pediatric condition with debated pathogenesis.
- GSF is understood as a single process arising from specific conditions: head injury, dural tear, and infancy.
- This condition alters intracranial pressure dynamics, leading to abnormal skull and brain growth.
Observation:
- GSF arises from a triad of factors: traumatic head injury with a gaping fracture, dural tear, and occurrence during infancy's rapid brain growth phase.
- This leads to altered intracranial pressure dynamics, causing the fracture to act as a 'neosuture' with abnormal skull growth.
- Associated findings include ventricular dilation and shifting towards the fracture site.
Findings:
- The study describes three successfully treated cases of GSF, even at a late stage.
- Surgical intervention demonstrated positive outcomes, confirming the efficacy of the treatment method.
Implications:
- The findings support a unified theory of GSF pathogenesis.
- Effective surgical management can yield good results, highlighting the importance of early recognition and intervention.
Abstract:
The growing skull fracture of childhood is a well-known but variously interpreted syndrome. Attempts have been made to find different pathogeneses for clinical and pathological patterns that are really successive phases of a single process, arising from the interaction of three basic conditions: (1) head injury with a large gaping fracture; (2) corresponding dural tear; (3) occurrence nearly always in infancy (the first year of life or period of maximum brain growth). This combination of factors alters the normal distribution of the intracranial pressure vectors and the fracture behaves like a "neosuture" with abnormal growth of the skull on the injured side. Simultaneously, the ventricular system tends to deform, dilating and shifting towards the side of the fracture. Three cases, successfully treated at a very late stage, are described. The good surgical results confirm the validity of the surgical method and its underlying theoretical basis.