Singhal G D, Atri Sanjeev, Suggala Sudheer, Jaluka Dinesh, Singhal Shakti, Shrivastava A K
Department of Neurosurgery, G B Pant Hospital, New Delhi, India.
Department of Neurosurgery, NIMS Medical College and Hospital, Jaipur, Rajasthan, India.
Asian J Neurosurg. 2021 Sep 14;16(3):539-548. doi: 10.4103/ajns.AJNS_183_18. eCollection 2021 Jul-Sep.
We performed a retrospective study of 67 patients and their data for radiological investigations by serial Xrays, computed tomography, magnetic resonance imaging, uniform surgical procedure of craniotomy. The results were analyzed to determine the natural course of the disease, anatomical changes at various intervals following trauma, and outcome of surgical procedure in terms of cranial reconstruction, seizures, and progress in neurological deficit.
Among 67 patients, 34 (50.74%) were male and 33 (49.26%) were female patients. About 86.67% of patients sustained the injury before the age of 3 years. Development of seizures in 28 patients (41.80%) is the most common symptom. In our study, 43.28% of patients (29 cases) had a combination of Type I and II of growing skull fracture. The dural defects confirmed in all cases were nearly twice (average 1.42) as large as the bone defects. All patients under the age of 3 years with diastatic skull fracture should be closely followed up and should be examined 2-3 months later to look for evidence of a growing skull fracture. Linear fractures and burst fractures in an infant with a scalp swelling must be corrected early to prevent a growing skull fracture.
Early management can avoid difficult surgical dissection and progressive neurological sequelae seen with delayed intervention. Surgical correction results in the prevention of brain shift and increase in meningocerebral cicatrices. Meticulous surgery and vigilant postoperative care reduce the morbidity and mortality. In our opinion, the autologous material is the best choice because of its tissue compatibility, convenience, inexpensiveness, and rare rate of infection.
我们对67例患者及其通过系列X线、计算机断层扫描、磁共振成像以及统一的开颅手术程序进行的放射学检查数据进行了回顾性研究。分析结果以确定疾病的自然病程、创伤后不同时间间隔的解剖学变化以及颅骨重建、癫痫发作和神经功能缺损进展方面的手术结果。
67例患者中，男性34例（50.74%），女性33例（49.26%）。约86.67%的患者在3岁之前受伤。28例患者（41.80%）出现癫痫发作是最常见的症状。在我们的研究中，43.28%的患者（29例）存在I型和II型生长性颅骨骨折。所有病例中确认的硬脑膜缺损几乎是骨缺损的两倍（平均1.42倍）。所有3岁以下的颅骨分离性骨折患者均应密切随访，并应在2 - 3个月后进行检查，以寻找生长性颅骨骨折的证据。婴儿头皮肿胀伴线性骨折和爆裂骨折必须尽早纠正，以防止生长性颅骨骨折。
早期处理可避免延迟干预时出现的困难手术解剖和进行性神经后遗症。手术矫正可防止脑移位并增加脑膜脑瘢痕形成。细致的手术和警惕的术后护理可降低发病率和死亡率。我们认为，自体材料是最佳选择，因为它具有组织相容性、便利性、廉价性以及低感染率。
