CRANIOCEREBRAL BIRTH TRAUMA CAUSED BY VACUUM EXTRACTION - A CASE OF GROWING SKULL FRACTURE AS A PERINATAL COMPLICATION

A case of growing skull fracture following birth trauma and caused by vacuum extraction is reported in order to emphasize the incidence of t his peculiar head injury at the beginning of extrauterine life and to point out its relation to possible neuropsychological disturbances tha t may appear later in childhood. Delivery by vacuum extraction increas es the incidence of perinatal injuries and consequently the incidence of neurological deficits in children. Neurosurgical repair is advocate d as the appropriate treatment, with the aim not only of cosmetically correcting the lesion's typical subgaleal protuberance with cranioplas ty, but also of performing a water-tight closure of the dura, enabling the cerebral cortex to ''fill in'' the intracerebral lesion. The surg ical technique and gross pathology of the lesion are described togethe r with radiological findings before and after surgery. Reports by othe r authors are reviewed in an attempt to identify the conditioning fact ors and pathological features of this traumatic injury to skull and br ain in neonates and infants. The literature on cranial fractures assoc iated with intracerebral lesions at this age shows a significant diffe rence in recovery and outcome from that after similar lesions in older children.