Fractura evolutiva: colocación de sistema derivativo cisto-peritoneal y corrección diferida: a propósito de un caso / Growing skull fracture: positioning system cisto-peritoneal derivative and correction deferred: report of a case

Describimos el caso de una paciente femenina de 5 años de edad, con antecedente de fractura craneal asociado a trauma directo en su segundo día de vida, posteriormente se diagnostica quistes porencefálico y aracnoideo frontoparietal izquierdo a los 3 meses de edad. Fue tratada en un primer momento con la colocación de sistema derivativo cistoperitoneal, y se le realizaron estudios de imágenes de seguimiento. A los 5 años de edad es traída a consulta de nuestro servicio de neurocirugía, por presentar deformidad calvarial en la superficie frontoparietal izquierda. El seguimiento con tomografía de cráneo demostró un cese relativo en la progresión en las dimensiones del quiste porencefálico y aumento del espacio entre los bordes óseos de la fractura. La paciente fue llevada a mesa operatoria, en la cual se realizó un abordaje hemicoronal izquierdo con resección de tejido gliótico, duroplastia con pericráneo y colocación de craneoplastía con tejido óseo craneal autólogo. El seguimiento al mes de la intervención correctiva mostró evolución satisfactoria y sin complicaciones. La cirugía correctiva de la fractura evolutiva, debe realizarse en el momento del diagnóstico para evitar su expansión. En concordancia con la teoría de Moss, se observa aumento del espacio entre los bordes de la fractura, aún con la disminución de la presión intracraneal al derivar el líquido cefalorraquídeo. En este caso, la intervención correctiva de la fractura, determinó una evolución satisfactoria, en ausencia de hidrocefalia o crisis convulsiva, posiblemente debida a la presión disminuida del quiste porencefálico sobre el parénquima subyacente.

We describe the case of a female patient of five years old, with a history of a skull fracture associated with direct trauma on his second day of life, then porencephalic left frontoparietal arachnoid cysts was diagnosed at 3 months of age. She was iniatially treated by plaing cystoeritoneal derivative system and follow-up imaging studies was performed. At 5 years of age is brought to clinic in our departmen of neurosurgery, for presenting calvarial deformity in the left frontoparietal area. The follow-p scan of the head showed a cease progression relative dimensions porencephalic cyst an increased space between the bone edges of the fracture. The patient was transferred to operating table, on which a hemicoronal left gliotico approach with resection of tissue was performed with dural graft placement craneoplasty bone tissue. Monitoring the month showed satisfactory corrective intervention and hassle evolution was performed with dural graft placement craneoplasty scalp and skull with autologous bone tissue. Corrective surgery of evolutionary fracture should be performed at the time of diagnosis to prevent its expansion. In agreement with the Moss theory, increasing the space between the edges of the fracture even with decreasing intracranial pressure deriving the cerebrospinal fluid was observed. In this case corrective intervention of the fracture produced a satisfactory outcome in the absence of hydrocephalus or seizure, possibly due to decreased pressure of porencephalic cyst on the underlying parenchyma.

4 Cases of Treatment of Growing Skull Fracture

A fracture of the skull occurred during the infancy and childhood ordinarily heals without difficulty. Rarely, however, such a fracture enlarges progressively to form a permanent cranial defect with pulsating mass. Patients usually have a history of head trauma and skull fracture and show pulsating soft mass with underlying bony defect. Pulsation of the brain is transmitted through the cysts to the inner table of the skull, and erosion of the bone ordinarily occurs in a localized area overlying the cysts. Enlargement of skull fractures has been reported at least 4 months after the accident. The existence of a dura defect in this syndrome has been amply verified by operative and autopsy observation, and appears to be a requisite for enlargement of the fracture. Ideal is early diagnosis and preventive treatment before it develops into a growing skull fractrue. Repeated simple radiology and color doppler sonography are very useful for evaluation of growing skull fracture. Also an early and aggressive operation is strongly recommended in young children. We experienced 4 cases of the growing skull fracture, which were reconstructed with cranioplasty and duraplasty. Clinical findings and management of the growing skull fracture are discussed, a review of the relevant literature is presented.

Acute Growing Skull Fracture: Case Report

Growing skull fracture is a rare complication of injury during infancy and childhood. About 90% of them occur in childhood under the age of 3 years. Growing skull fracture or leptomeningeal cyst was known to be formed through the bony erosion of fractured site by cerebrospinal fluid pulsation of the leptomeninges, impacted into the fractured bone by trauma. Most growing skull fractures are located in the parietal region. A growing fracture commonly presents as a progressive, often pulsatile, scalp mass that appears several months to years after head injury sustained during infancy or early childhood. The authors report a case of acute growing skull fracture in 4-year-old male patient, which developed 3 weeks after fall down injury.

Recurrent Meningitis due to Growing Basal Skull Fracture of Orbital Roof: A Case Report

A 6-year old boy was admitted with high fever and redness of the right eyelids and the surrounding area. He had previously suffered cerebral contusion, basal skull fracture and pneumocephalus following a traffic accident which required six months' hospitalization. Since then, and prior to admission, he had twice suffered probable bacterial meningitis and had been treated at an outstanding hospital. At the time of this admission, the patient again developed high fever, with redness of the right eyelid and surrounding area. His symptomatology suggested bacterial meningitis and cerebrospinal fluid culture revealed Streptococcus pneumoniae sensitive to penicillin. In accordance with the clinical course of meningitis and accompanying sinusitis, the appropriate antibiotic and its duration of usage were determined. Recurrent episodes of bacterial meningitis in this child raised the possibility of anatomical defect as an a contributory factor. Computerized tomographic(CT) cisternography suggested leakage of cerebrospinal fluid and revealed herniated frontal brain tissue protruding through a gap in the right frontal skull base, three dimensional CT(3-D CT) confirmed this defect, which was 3X4cm in size. After recovery from meningitis, surery to prevent recurrent meningitis, was performed. To locate pathologic areas, the subfrontal approach,involving bicoronal skin incision and bifrontal bone flap was used. Multiple fracture lines and a large bony defect on the orbital roof were observed, together with a dural defect, through which cerebromalatic tissue was herniated as encephalocele. Using lyophilized dura, the dural defect was made watertight; the bony defect was packed with autologous fats and covered with titanium mesh. The patient improved after surgery. Recurrent meningitis with anatomical pathologic focus after head trauma requires surgical intervention.

Evaluation of Three-Dimentional Computerized Tomography Image of the Growing Skull Fracture on the Orbital Roof

Growing skull fracture is a rare complication of a closed head injury during infancy and childhood. Most growing skull fracture are located in the parietal region. The authors report a case of growing skull fracture of the orbital roof using three dimentional computerized tomography(3-D CT) imaging, the shpae and the size of defect were clearly demonstrated.

Growing Skull Fracture: A Case Report

The growing skull fracture represents a particular type of evolution of cranial fracture in young children, and has also been called leptomeningeal cyst. This rare fracture usually occurrs in the parietal region of the skull in infancy, and underlying dura tear is the single most important factor in the process. We are reporting a patient with a posttraumatic growing skull fracture that we have treated surgically.