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Enlarging skull fractures in children
1Division of Neurosurgery, Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
Summary
Large skull fractures in children often appear to grow but are rarely true leptomeningeal cysts. Clinical evaluation, not imaging, can accurately diagnose these injuries.
Area of Science:
- Pediatric Traumatology
- Neurosurgery
- Radiology
Background:
- Large skull fractures in children are typically monitored with serial radiography.
- Unhealed or enlarging fractures are often misdiagnosed as leptomeningeal cysts or growing skull fractures.
Purpose of the Study:
- To investigate the nature of enlarging or unhealed skull fractures in children.
- To determine if imaging is necessary for diagnosing these injuries.
Main Methods:
- Review of ten pediatric cases with large skull fractures.
- Comprehensive literature review on the topic.
Main Results:
- True leptomeningeal cysts are rarely found in these cases.
- Skull fractures do not inherently "grow"; apparent enlargement is due to other factors.
- Clinical assessment (history and physical examination) is sufficient for diagnosis.
Conclusions:
- The terms "leptomeningeal cyst" and "growing skull fracture" are often inaccurately applied.
- Accurate diagnosis of enlarging or unhealed skull fractures in children can be achieved through clinical evaluation alone.
- Routine radiographic or CT follow-up is unnecessary for these specific pediatric skull injuries.