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Growing skull fractures: strategies for repair and reconstruction
1Division of Plastic Neurosurgery, Saint Louis University Health Sciences Center, MO.
Insights
Growing skull fractures, a rare complication of pediatric head injuries, can enlarge due to dural tears. Prompt surgical repair ensures reliable aesthetic and functional restoration in children.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Traumatology
- Pediatric Craniofacial Surgery
Background:
- Most pediatric skull fractures heal without issue.
- Skull fractures in infants linked to dural injuries may enlarge, termed growing skull fractures.
- This enlargement results from leptomeningeal herniation at dural tear sites.
Purpose of the Study:
- To report on the prevalence of growing skull fractures in pediatric head injuries.
- To describe the surgical management and outcomes of growing skull fractures.
Main Methods:
- A 6-year retrospective review of pediatric head injuries at Cardinal Glennon Children's Hospital.
- Analysis of seven cases of growing skull fractures within a cohort of 592 pediatric head injuries.
- Surgical intervention involving regional craniectomy, pericranial dural inlay graft, and cranial bone graft reconstruction.
Main Results:
- Seven growing skull fractures were identified, yielding a prevalence of 1.2%.
- Surgical repair included craniectomy with dural grafting and immediate contour reconstruction.
- The described surgical technique ensured reliable aesthetic and functional restoration.
Conclusions:
- Growing skull fractures are a rare but significant complication of pediatric head trauma.
- Prompt surgical intervention is crucial for optimal neurocranial restoration.
- A combined approach of dural repair and cranial reconstruction yields reliable outcomes.
Abstract:
Most skull fractures in growing children heal rapidly and without significant contour irregularity. Skull fractures in infants associated with dural injuries, however, may progressively enlarge as a result of bone erosion by leptomeningeal herniation at the dural tear sites and are known as "growing skull fractures." Over a 6-year period, seven growing skull fractures occurred in a population of 592 consecutive pediatric head injuries at Cardinal Glennon Children's Hospital (prevalence, 1.2%). Prompt recognition of growing skull fractures, repair by regional craniectomy and pericranial dural inlay graft, and immediate contour reconstruction with rigidly fixed cranial bone graft ensure reliable aesthetic and functional restoration of the growing neurocranium.