Muhonen M G, Piper J G, Menezes A H
Division of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Surg Neurol. 1995 Apr;43(4):367-72; discussion 372-3. doi: 10.1016/0090-3019(95)80066-p.
Growing skull fractures are poorly understood complications of pediatric skull fractures.
A retrospective review of skull fractures at our institution from 1980-1993 revealed 10 patients with growing skull fractures. The age at injury ranged from 1-144 months, with 9 of 10 patients being under one year of age. The etiology of these fractures included falls, motor vehicle accidents, and child abuse. On average, growth of the fracture was diagnosed 14 months after the initial injury.
Six patients have had magnetic resonance imaging (MRI) with one demonstrating leptomeningeal cyst herniation, two having brain herniation, and three having both brain parenchyma and leptomeningeal cyst herniation. All patients had malacic cortex underlying the fracture, but there was no evidence of intracranial hypertension. Nine patients have undergone craniotomy with excision of granulation tissue and gliotic brain, dural repair, and cranioplasty using surrounding normal skull. There were no surgical complications or recurrences.
Brain/leptomeningeal cyst herniation through a dural rent, without MRI evidence of increased intracranial pressure, implicates physiologic growth and brain cerebrospinal fluid (CSF) pulsations as the cause of fracture enlargement.
儿童颅骨骨折的并发症——生长性颅骨骨折鲜为人知。
对我院1980年至1993年期间的颅骨骨折进行回顾性研究，发现10例生长性颅骨骨折患者。受伤年龄为1至144个月，10例患者中有9例年龄在1岁以下。这些骨折的病因包括跌倒、机动车事故和虐待儿童。骨折生长平均在初次受伤后14个月被诊断出来。
6例患者进行了磁共振成像（MRI）检查，其中1例显示软脑膜囊肿疝出，2例有脑疝，3例既有脑实质疝出又有软脑膜囊肿疝出。所有患者骨折下方均有软化的皮质，但无颅内高压证据。9例患者接受了开颅手术，切除肉芽组织和胶质化脑，修补硬脑膜，并使用周围正常颅骨进行颅骨成形术。无手术并发症或复发。
脑/软脑膜囊肿通过硬脑膜裂口疝出，且MRI未显示颅内压升高，这意味着生理生长和脑脑脊液（CSF）搏动是骨折扩大的原因。
