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April2010 Vol.47 Issue:        2        Table of Contents
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Growing Skull Fractures: Clinical Study of 10 Patients

Ahmed Saleh1, Islam  Aboulfetouh1, Naser Mosad1, Fathy Elnos1, Mohamed Lotfy2

 

Department of Neurosurgery, Benha University1, Cairo University2; Egypt

 



ABSTRACT

Background: Cranial burst fracture is a wide diastatic skull fracture associated with dural laceration and extrusion of cerebral tissue outside the calvaria beneath an unbroken scalp. Growing skull fractures can develop when dural and arachnoid tears remain unrepaired. To improve the early detection and evaluation of infants with growing skull fractures, meticulous clinical examinations and radiological investigations including MR imaging must be evolved. Objective: The aim of this retrospective study was to evaluate the role of early repair of cranial burst fracture in prevention of  complications associated with growing skull fractures. Methods: Ten infants aged 1 through 13 months who sustained cranial burst fractures, all initially imaged with skull radiography and CT, were studied and treated from 2004 through 2008. MR imaging was obtained after resuscitation and stabilization in some selected cases. Reduction of herniated neural tissue, dural repair, and skull reconstruction are best performed after acute cerebral swelling has subsided but before cortical parasitization of scalp vessels and scarring have occurred. Results: Neuroimaging studies delineate the injury: dural laceration and extrusion of cerebral cortex. Surgery confirmed radiological findings (dural laceration and extracalvarial cerebral tissue) in all our patients. Prompt reduction of the cerebral hernia followed by dural repair prevents a growing skull fracture. Conclusion:  Identification and follow up of diastatic skull fracture before the chronic neuropathologic changes of growing fracture developed, facilitates safe repair and may minimize ongoing cerebral injury. Early prompt repair of diastatic skull fractures with scalp swelling in young child may prevent further brain dehiscence and neurologic injury. (Egypt J Neurol Psychiat Neurosurg.  2010; 47(2): 249-254)

Correspondence to Ahmed Saleh. Department of Neurosurgery, Benha University, Egypt.. Tel. +20109287151. Email: Ahmedsaleh_s@yahoo.com





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