Expanding cranial defects following craniofacial surgery

Growing skull fractures or posttraumatic leptomeningeal cysts are a known complication of skull fractures sustained in infancy and childhood. They usually present as progressively enlarging cranial masses at the site of the linear skull fractures. The pathogenesis is believed to require an underlying dural tear that allows herniation of the growing pulsatile brain and leads to resorption of the overlying bone. Similar enlarging cranial masses have been reported following craniofacial surgery. Our case occurred following reconstruction of a stenosed metopic suture. The treatment of this unusual complication of craniofacial surgery requires sound dural repair. An understanding of the similarity between this complication and the more common growing skull fractures of childhood is essential to a sound approach to diagnosis and treatment.