UNTREATED GROWING CRANIAL FRACTURES DETECTED IN LATE-STAGE

OBJECTIVE: Because the great majority of published cases of treated gr owing cranial fractures (GCFs) involved infants and children, the natu ral evolution of untreated GCFs is not well known.The question of whet her untreated GCFs may cause progressive neurological deficits is cont roversial. METHODS: This retrospective study is of GCFs treated betwee n 1989 and 1997. Nine patients (eight male patients and one female pat ient; median age, 20.5 yr) with GCFs who underwent surgical interventi on during the late stage are presented. The dural and cranial defects were repaired, and additional decompressive surgical procedures (cyst fenestration, n = 6; cyst excision, n = 1; cyst excision with cystoper itoneal shunting, n = 2) were performed for all patients. This is the largest of the published series. RESULTS: AII of the patients had hist ories of severe head trauma that occurred during childhood. The averag e age at the time of the onset of symptoms was approximately 13.1 year s, and the interval between head injury and first symptom ranged from 8 to 13 years. All of the patients had lytic lesions in the cranium. H eadache was the most common symptom, and of eight patients, seven impr oved completely and one improved partially. One of four epileptic pati ents was seizure-free postoperatively. None of the paresis improved, e xcept in one patient. CONCLUSION: We conclude that untreated GCFs may cause delayed onset neurological manifestations in addition to cranial growth asymmetry. GCFs, discovered incidentally in adolescence or adu lthood without any neurological deficits, should be operated on as soo n as feasible to prevent further brain destruction. Cranioplasty with dural repair, in addition to cyst fenestration, should be considered a s the essential procedure for the treatment of these lesions.