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Untreated growing cranial fractures detected in late stage
M Kutlay1, N Demircan, O N Akin
1Department of Neurosurgery, Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Istanbul, Turkey.
Insights
Untreated growing cranial fractures (GCFs) can lead to delayed neurological problems and skull deformities. Early surgical repair is recommended to prevent further brain damage and improve outcomes.
Area of Science:
- Neurosurgery
- Pediatric Neurosurgery
- Trauma Surgery
Background:
- Growing cranial fractures (GCFs) are rarely studied in untreated cases, with most literature focusing on infant/childhood GCFs.
- The potential for untreated GCFs to cause progressive neurological deficits remains controversial.
Purpose of the Study:
- To investigate the natural evolution and late-stage presentation of growing cranial fractures (GCFs).
- To evaluate the neurological manifestations and outcomes of surgically treated GCFs in adolescents and adults.
Main Methods:
- Retrospective analysis of nine patients (median age 20.5 years) with GCFs treated between 1989 and 1997.
- Surgical intervention included dural and cranial defect repair, with decompressive procedures like cyst fenestration, excision, or shunting.
Main Results:
- All patients had a history of severe childhood head trauma and presented with lytic cranial lesions.
- Symptoms, including headache and neurological deficits, appeared 8-13 years post-injury, with most headaches resolving post-surgery.
- Surgical outcomes showed improvement in headaches, partial improvement in epilepsy, but limited recovery from paresis.
Conclusions:
- Untreated GCFs can result in delayed neurological deficits and cranial asymmetry.
- Prompt surgical intervention (cranioplasty with dural repair and cyst fenestration) is advised for GCFs detected in adolescence/adulthood to prevent brain destruction.
Objective:
Because the great majority of published cases of treated growing cranial fractures (GCFs) involved infants and children, the natural evolution of untreated GCFs is not well known. The question of whether untreated GCFs may cause progressive neurological deficits is controversial.
Methods:
This retrospective study is of GCFs treated between 1989 and 1997. Nine patients (eight male patients and one female patient; median age, 20.5 yr) with GCFs who underwent surgical intervention during the late stage are presented. The dural and cranial defects were repaired, and additional decompressive surgical procedures (cyst fenestration, n = 6; cyst excision, n = 1; cyst excision with cystoperitoneal shunting, n = 2) were performed for all patients. This is the largest of the published series.
Results:
All of the patients had histories of severe head trauma that occurred during childhood. The average age at the time of the onset of symptoms was approximately 13.1 years, and the interval between head injury and first symptom ranged from 8 to 13 years. All of the patients had lytic lesions in the cranium. Headache was the most common symptom, and of eight patients, seven improved completely and one improved partially. One of four epileptic patients was seizure-free postoperatively. None of the paresis improved, except in one patient.
Conclusion:
We conclude that untreated GCFs may cause delayed onset neurological manifestations in addition to cranial growth asymmetry. GCFs, discovered incidentally in adolescence or adulthood without any neurological deficits, should be operated on as soon as feasible to prevent further brain destruction. Cranioplasty with dural repair, in addition to cyst fenestration, should be considered as the essential procedure for the treatment of these lesions.