Fractura con hundimiento de cráneo intrauterina espontánea: reporte de dos casos / Spontaneous intrauterine depressed skull fracture: report of two cases

Las fracturas con hundimiento de cráneo intrauterinas representan una entidad poco frecuente, generalmente secundaria a traumatismos (previos o durante el nacimiento) o de etiología desconocida. Suelen requerir evaluación y seguimiento por el servicio de Neurocirugía Pediátrica. A la fecha, es controversial la necesidad de tratamiento quirúrgico y el momento oportuno para concretarlo. Se presentan dos casos clínicos de pacientes de término, nacidas porcesárea,condiagnósticoposnatalinmediatodehundimiento de cráneo de tipo ping-pong no traumático. Ambas pacientes presentaron examen neurológico normal. Se confirmó el diagnóstico a través de radiografía y tomografía de cráneo, sin observarse lesiones asociadas. Fueron valoradas por el servicio de Neurocirugía, que indicó corrección quirúrgica de la lesión en ambos casos, con buena evolución posterior.

Spontaneous intrauterine depressed skull fractures are a rare entity. They can appear secondarily to head trauma (before or during birth) or due to unknown etiology. They usually require a complete evaluation from pediatric neurosurgery specialists. Their optimal management, including timely surgical treatment remains controversial. We describe two cases delivered by cesarean section, with postnatal diagnosis of spontaneous intrauterine depressed skull fracture. Both had a normal neurological exam. A skull radiography and head CT were performed, and no associated lesions were found. Both cases required surgical correction, with positive results.

Use of Vacuum-suction in Depressed Skull Fractures ­ Case Report and Technical Nuances of Nonoperative Treatment

Up to 20% of victims from skull fractures are represented by the pediatric population, and 50% of these lesions are depressed skull fractures. The treatment is multimodal in nature, ranging from conservative treatment to open surgical repair. The last one is associated, although in a small proportion, to complications, such as infections, hematomas and even death, besides the risks of the anesthetic procedure itself. The authors of the present article present a case report of the successful treatment of a depressed skull fracture in a newborn patient, using the vacuum-suction technique. The use of vacuum-suction may be beneficial for the pediatric patients, as it is a quick, non-invasive procedure, without the need for general anesthesia.

Compound depressed skull fractures overlying dural venous sinuses

The purpose of this study was to characterize the patients with compound depressed skull fractures overIying dural venous sinuses clinically and radiologically and to discuss the patients' circumstances that favour conservative or surgical treatment, in addition to the outcome. Of 192 patients with depressed skull fractures admitted to our Neurosurgical Department, Assiut University Hospital between January 2004 to December 2005, 30 patients [15.6%] with compound depressed skull fractures over a dural venous sinus were prospectively studied. There were 27 [90%] males and 3 [10%] females. Eighteen patients [60%] were paediatrics [3- 18 yrs] while 12 [40%] were adults [20-60 yrs]. Twenty-four patients had a Glasgow Coma Scale [GCS] of 14- 15/15, 3 patients had a GCS of 9- 13 and 3 patients had a GCS of <8. Aetiological falls and motor vehicle accident were predominant in the paediatric group while among adults assault and motor vehide accident were predominant. The superior sagittal sinus was the most commonly involved sinus [28 out of 30 patients = 93.3%] with anterior injuries more common than posterior ones [26 out of 28 patients = 92.9%]. Thirteen patients [43.3%] were treated conservatively and 17 [56.7%] patients were treated surgically; either initially in 15 cases due to the presence of neurological deficit, underlying haematoma, egress or escape of intracranial contents and/or deep contamination, or later on in the other 2 cases due to development of intracranial hypertension. lntraoperative difficulty was experienced in 8 [47.1%] patients. Of those treated non-operatively, 3 [23.1%] patients developed wound infection while wound infection among those treated operatively was seen in 2 [11.8%] patients. There was no mortality and the neurological deficit was reversed with the aid of physiotherapy by time and the patients returned to their daily activities. Our opinion favours conservative approach to fractures involving a dural sinus, if the wound is not contaminated, as the risk of infection is low. Surgery exposes the patient to the very real risk of massive haemorrhage. In instances where there is a clear need for surgery adequate precautions should be taken. Computed tomographic venography is a reliable tool for demonstrating early sinus compression and/or occlusion that facilitates surgical decision. However, delayed intracranial hypertension is a possible complication and should always be considered in patients with the appropriate clinical findings in the follow-up period