From the Department of Plastic and Reconstructive Surgery and the Department of Neurological Surgery, Division of Pediatric Neurosurgery, The Johns Hopkins Hospital; and the Division of Plastic and Reconstructive Surgery, Rush University Medical Center.
Plast Reconstr Surg. 2020 May;145(5):953e-962e. doi: 10.1097/PRS.0000000000006745.
Currently, the pathogenesis of leptomeningeal cysts, also known as growing skull fractures, is still debated. The purpose of this study was to examine the specific skull fracture characteristics that are associated with the development of growing skull fractures and describe the authors' institutional experience managing this rare entity.
A retrospective cohort study was performed that included all patients younger than 5 years presenting to a single institution with skull fractures from 2003 to 2017. Patient demographics, cause of injury, skull fracture characteristics (e.g., amount of diastasis, linear versus comminuted fracture), concomitant neurologic injuries, and management outcomes were recorded. Potential factors contributing to the development of a growing skull fracture and neurologic injuries associated with growing skull fractures were evaluated using univariate logistic regression.
A total of 905 patients met the authors' inclusion criteria. Of these, six (0.66 percent) were diagnosed with a growing skull fracture. Growing skull fractures were more likely to be comminuted (83.3 percent versus 40.7 percent; p = 0.082) and to present with diastasis on imaging (100 percent versus 26.1 percent; p < 0.001; mean amount of diastasis, 7.1 mm versus 3.1 mm; p < 0.001). Univariate logistic regression analysis confirmed the role of a comminuted fracture pattern (OR, 7.572) and the degree of diastasis (OR, 2.081 per mm diastasis) as significant risk factors for the development of growing skull fractures.
The authors' analysis revealed that fracture comminution and diastasis width are associated with the development of growing skull fractures. The authors recommend dural integrity assessment, close follow-up, and early management in young children who present with these skull fracture characteristics.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
目前，脑膜膨出（又称颅骨生长性骨折）的发病机制仍存在争议。本研究旨在探讨与颅骨生长性骨折发生相关的特定颅骨骨折特征，并描述作者所在机构对这一罕见疾病的治疗经验。
本研究采用回顾性队列研究方法，纳入了 2003 年至 2017 年期间在一家机构就诊的所有年龄小于 5 岁、伴有颅骨骨折的患者。记录患者的人口统计学资料、损伤原因、颅骨骨折特征（如，分离程度、线性或粉碎性骨折）、并发的神经损伤和治疗结局。使用单变量逻辑回归评估可能导致颅骨生长性骨折发生的因素和与颅骨生长性骨折相关的神经损伤。
共纳入 905 例患者，其中 6 例（0.66%）被诊断为颅骨生长性骨折。颅骨生长性骨折更可能为粉碎性（83.3%对 40.7%；p=0.082），影像学上表现为分离（100%对 26.1%；p<0.001；平均分离程度为 7.1mm 对 3.1mm；p<0.001）。单变量逻辑回归分析证实了粉碎性骨折模式（OR，7.572）和分离程度（OR，每增加 1mm 分离 2.081）是颅骨生长性骨折发生的显著危险因素。
作者的分析表明，骨折粉碎和分离宽度与颅骨生长性骨折的发生有关。作者建议对具有这些颅骨骨折特征的幼儿进行硬脑膜完整性评估、密切随访和早期治疗。
临床问题/证据水平：风险，III 级。
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