GROWING SKULL FRACTURES - A CLINICAL-STUDY OF 41 PATIENTS

Growing skull fractures are rare complications of head injury, occurri ng almost exclusively in infants and children under the age of three. A retrospective review at our Institute yielded 41 patients with this entity over a period of 20 years (1975-1995). The age at presentation ranged from less than 1 year to 62 years, with 33 (80.5%) patients bei ng less than 5 years of age. The cause of injury was either a fall fro m a height (93%) or a road traffic accident. The most common location of a growing skull fracture was either parietal or frontoparietal (56% ). One patient had a posterior fossa growing skull fracture. CT scan w as performed in 19 patients which demonstrated an underlying porenceph alic cyst, hydrocephalus or a cyst communicating with the ventricle. I n 5 children, a ventriculo-peritoneal shunt alone was per formed. Twen ty four patients underwent a duro- and cranioplasty while a duroplasty alone was performed in 8 patients. The material used for cranioplasty included acrylic, wire mesh, steel plates or autologous bone. Three p atients died, one due to an anaesthetic complication and two as a resu lt of postoperative meningitis. Postoperative CSF leaks occurred in 3 patients, which were managed by a lumbar drain. Six patients had local wound infection.