THE VALUE OF MRI IN THE EARLY DIAGNOSIS OF GROWING SKULL FRACTURE

Growing skull fracture (GSF) is a progressive enlargement of a fractur e due to an underlying tear of the dura mater. It is a rare complicati on of severe head injury mainly reported in young children. Classicall y, the diagnosis is made during follow-up, late after the original inj ury, when a palpable skull defect or a bulging mass is discovered clin ically. Initial skull radiographs show a diastatic fracture developing later into a large bony defect. CT will show the brain damage which i s usually present beneath the fracture. We present the MRI findings of GSF in a series of eight children. All patients initially had a large linear fracture and underlying brain damage on CT. In all cases MRI s howed a zone of the same in tensity as the brain contusion or cerebros pinal fluid advancing through the bone margins of the fracture to the subcutaneous plane. This finding was interpreted as an indirect sign o f the dural tear. Seven patients were operated on with surgical confir mation of GSF. MRI can make an early diagnosis of GSF possible so that surgical repair with closure of the dura can be carried out before th e dural tear enlarges.