Skull Subsidence due to Periosteum Defect following Craniotomy in a Child
Hidetaka Arishima1, Ayumi Akazawa, Ken-Ichiro Kikuta
1Department of Neurosurgery, University of Fukui, Fukui, Japan.
Insights
A periosteum defect after pediatric craniotomy can cause skull deformity. Preserving the periosteum during neurosurgery in children is crucial to prevent abnormal skull growth and deformities.
Area of Science:
- Pediatric Neurosurgery
- Craniofacial Surgery
- Developmental Biology
Background:
- A 7-year-old child developed a cranial deformity after surgery for an intracranial hematoma.
- The initial injury involved a temporal bone fracture and epidural hematoma.
- A large skin flap was created, but a smaller craniotomy was performed without decompression.
Purpose of the Study:
- To investigate the cause of a cranial deformity in a pediatric patient post-craniotomy.
- To identify the surgical factors contributing to the observed skull abnormality.
- To recommend preventive measures for similar cases in pediatric neurosurgery.
Main Methods:
- Case report of a pediatric patient.
- Review of surgical procedure and patient history.
- Analysis of computed tomography (CT) scans (axial and 3D) to assess skull morphology.
- Correlation of imaging findings with surgical technique and periosteal integrity.
Main Results:
- The patient developed forehead depression and skull deformity 18 months post-surgery.
- CT scans revealed thinness and subsidence of the frontoparietal bone near the bone flap.
- A defect in the periosteum associated with the large skin flap was identified as the likely cause.
Conclusions:
- Periosteum defects resulting from large skin flaps in pediatric craniotomies can impede normal skull growth.
- This impediment can lead to significant cranial deformities, including bone thinning and subsidence.
- Preservation and coaptation of the periosteum are recommended during pediatric neurosurgery to prevent such deformities.
Abstract:
We report a case of a 7-year-old child with a cranial deformity secondary to a craniotomy for an intracranial hematoma. He suffered from an acute epidural hematoma with a lineal fracture of the right temporal bone following a severe head injury. A large question mark-shaped skin flap with the periosteum and temporal muscle was created for a decompressive craniectomy; however, neither the acute epidural hematoma nor brain swelling was severe, and we performed a small craniotomy compared with the skin flap without a decompressive craniectomy. Eighteen months after the operation, he complained of skull deformity with a mild depression of the forehead. Axial and 3-dimensional computed tomography showed thinness and subsidence of the frontoparietal bone around the replaced bone flap, corresponding to the skin flap with the periosteum defect. We suggest that the periosteum defect following creation of the skin flap during surgery prevented normal growth of the skull, which caused the thinness and subsidence of the frontoparietal bone. Preservation and cooptation of the periosteum should be performed during neurological surgeries in babies and children to prevent skull deformity.
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