Nota Clínica

Recurring post-traumatic growing skull fracture

I. San Martín-García, S. Aguilera-Albesa, I. Zazpe-Cenoz, M.E. Yoldi-Petri [REV NEUROL 2015;60:351-354] PMID: 25857859 DOI: https://doi.org/10.33588/rn.6008.2014472

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Volumen 60 | Number 08 | Nº of views of the article 10.205 | Nº of PDF downloads 340 | Article publication date 16/04/2015

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ABSTRACT

INTRODUCTION Growing skull fracture, also known as post-traumatic bone absorption or leptomeningeal cyst, is a rare complication of traumatic brain injuries and occurs almost exclusively in children under 3 years of age.

CASE REPORT We report the case of a 6-month-old child who presented, two months after an apparently unimportant traumatic skull injury, persistence of left temporoparietooccipital cephalohaematoma with no other signs. A transfontanellar ultrasonography scan revealed a bone defect with brain herniation, and computerised tomography and magnetic resonance imaging also confirmed the existence of a growing fracture. Excision of the leptomeningeal cyst, dural closure and repair of the bone defect with plates and lactate material were performed. Three months after the operation, the patient still presented collection of fluid and recurrence of the growing fracture was confirmed. Following the second operation, a baby helmet was fitted in order to prevent renewed recurrences. One year after the traumatic injury occurred, the patient remains asymptomatic.

CONCLUSIONS Any child under 3 years of age with a post-traumatic cephalohaematoma should be checked periodically until the full resolution of the collection of fluid, especially if they present a fractured skull. The presence of a cephalohaematoma that remains more than two weeks after traumatic brain injury must make us suspect a growing fracture and reparation of the dura mater and a cranioplasty will be needed to treat it. The use of resorbable material allows it to be remodelled as the patient’s skull grows, but its fragility increases the risk of recurrence. The use of a baby helmet after the operation could prevent complications. KeywordsCephalohaematoma Cranioplasty Growing fracture Leptomeningeal cyst Paediatric patient Traumatic skull injury CategoriesTraumatismos

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Nota Clínica

Recurring post-traumatic growing skull fracture