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.

Clinical Analysis of Linear Skull Fractures

A retrospective analysis of 351 linear skull fractures, during the period of January 1, 1992 to December 31, 1993, reveals the following: 1) Motor-Vehicle-related accidents were responsible for most of the injuries(56%), in which pedestrians(47%) were the primary victims. 2) In 172 cases(49%), the Glasgow Coma Scale(GCS) ranged from 13 to 15. Patients wth parietal fractures usually rated on a lower scale than those with fractures on other sites. 3) Occipital fractures were most common(23%), which was followed by parietal(19%), temporal(15%), frontal(15%), and multiple fractures(8%). Occipital fractures were frequently due to a pedstrian T.A. or a fall from high elevation while temporal or parietal fractures were frequently due to bicycle and motorcycle accidents. 4) The incidence of associated intracranial lesions was 70%. Patients with occipital fractures had a lower percentage of associated intracranial lesions than those with parietal fractures. Coup injuries were found in 175 cases and contre coup injuries in 106 cases. In many cases, frontal, parietal and temporal fractures were found to be coup injuries whereas with occipital fractures, contre coup injuries. 5) Sixty-one percents of the patients were assessed in Glasgow Outcome Scale(GOS) grade I.