The author describes 2 cases of children with growing skull fractures (GSFs). Surgical exploration of the widened fracture shortly after the head injury failed to reveal a dural tear because the neuroimaging studies (MR images, CT scans, and skull radiographs) had not been accurately interpreted, thereby allowing the development of a GSF at the site of the actual dural injury. In both cases, the dural and bony defect and the leptomeningeal cyst were successfully repaired.
To prevent GSFs associated with progressive neurological deficit, seizure, ventricular porencephaly, and encephalomalacia, the author surgically explores wide skull fractures in young children with head injury whose MR images demonstrate brain herniation through the dura mater. The importance of a brief delay in surgical exploration is emphasized to allow cerebral edema to resolve and the patient's condition to become medically stabilized.
Address correspondence to: Robert A. Sanford, M.D., Department of Pediatric Neurosurgery, University of Tennessee Health Science Center, 6325 Humphrey's Boulevard, Memphis, Tennesee 38120. email:
TandonPN, , BanerjiAK, , BhatiaR, & GoulatiaRK: Cranio-cerebral erosion (growing fracture of the skull in children). Part II. Clinical and radiological observations. Acta Neurochir (Wien)88:1–9, 1987
TandonPN, BanerjiAK, BhatiaR, GoulatiaRK: Cranio-cerebral erosion (growing fracture of the skull in children). Part II. Clinical and radiological observations. Acta Neurochir (Wien)88:1–9, 1987)| false