Internal open brain injury or cranial burst fracture: report of 8 cases.

AIMS

We report a special type of skull fracture in children - internal open brain injury (IOBI). We summarize its clinical characteristics and propose a treatment strategy based on our experience.

METHODS

Eight patients between 2 and 5 years old were identified to have IOBI. Preoperative computed tomography (CT) scanning was performed in each case and magnetic resonance imaging was conducted when available. All patients were treated surgically. The clinical data were retrospectively analyzed and each patient underwent follow-up CT scanning.

RESULTS

IOBI has no special clinical manifestations other than scalp swelling, linear skull fracture and local brain contusion. Acute cerebral extrusion outside the calvaria and lacerated dura mater were seen during operation in each patient. Each patient's neurological status generally improved after surgery. No patient developed posttraumatic epilepsy during the 4- to 20-month follow-up period.

CONCLUSIONS

IOBI is a type of head trauma in which dura mater is lacerated and the cerebrum is extruded outside the calvaria but the scalp remains intact. Craniotomy with evacuation of devitalized brain tissue and dural repair should be performed.