Surgical Repair of Growing Skull Fracture: A Case Report

Abstract

Background: Growing skull fractures (GSF) are a rare complication of pediatric head trauma that comprises post-traumatic skull defect associated with an underlying dural tear and an intact arachnoid membrane. They are often misdiagnosed, and delay in management can lead to progression of the disease with neurological sequelae. GSF are rare and their incidence has been estimated as 0.05% - 1% of all pediatric skull fractures. This low incidence and the subtlety of its presentation often make diagnosis challenging with consequent delay in management. Surgery is recommended to treat GSF and involved dural repair with or without cranioplasty. In this paper, we report a case of a patient with GSF in whom the surgical repair was successful with good cosmetic and functional outcome. Case Report: A 12 months old girl was admitted to our neurosurgical department with right parietal swelling that had been gradually enlarging over 3 months. The history of the disease began when the girl was 1 month old with a fall with cranial impact resulting in head trauma with initial loss of consciousness. At presentation the girl was alert with normal consciousness. Clinical examination revealed the deformed skull with large pulsatile and painless swelling lesion in the right parietal region and hemiparesis on the left side. The CT scan revealed type 3 GSF including parietal bone diastasis with hypodense fluid collection that mimicked the leptomeningeal and porencephalic cyst. Surgical repair was performed. The post-operative course was uneventful and the child was discharged home five days after surgical intervention. Conclusion: GSF can lead to serious neurologic complications. Therefore educating parents on this potential outcome and close follow-up with clinical and imaging screening is recommended to screen children at risk for the development of the disease.