The growing skull fracture, a rare complication of paediatric head injury
The growing skull fracture, a rare complication of paediatric head injury
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不断增长的颅骨骨折是小儿颅脑损伤的罕见并发症
DOI：
10.1007/s00431-003-1256-1
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发表时间：
2003
影响因子：
3.6
通讯作者：
J. Grotenhuis
中科院分区：
文献类型：
--
作者：
B. Zegers;P. Jira;M. Willemsen;J. Grotenhuis
幼儿的线性颅骨骨折有时会导致颅骨骨折不断增长。通过颅骨成形术硬脑膜修复来神经外科矫正生长性颅骨骨折（GSF）被认为是一种安全有效的治疗方法，预后良好。一名三个月大的男孩从楼梯上摔下来，头朝下摔在地板上。最初他没有表现出任何神经系统症状。颅骨造影显示右侧枕顶骨线性骨折。颅脑计算机断层扫描显示右侧硬膜下出血，骨折部位下方扩大，右半球挫伤和肿胀，导致中线适度移位。他被转移到儿科重症监护室接受进一步评估和观察。入院后，他逐渐失去知觉，并出现右侧固定眼。最低 EMV 分数为 1–4-T。通过脑室内探头测量的颅内压保持正常。颅内出血选择保守治疗，人工通气、镇静3天。他出现左臂轻瘫和暂时性局灶性癫痫活动。这个问题在出院后的几个月内得到了解决。然而，10 个月大时（出院后 7 个月）的体格检查发现，右侧枕顶头皮上有一个柔软的搏动性肿块。在颅骨的不连续部分周围感觉到骨脊。头颅平片显示枕顶骨有较大缺损。颅脑磁共振成像显示囊性脑软化症、右心室扩张以及脑组织轻度疝入颅骨缺损（图 1）。进行了手术矫正，包括硬脑膜修复术以解决疝出问题，以及颅骨成形术以覆盖硬脑膜和颅骨缺损。在手术过程中，骨缺损似乎被组织覆盖，随后在显微镜下确定为肉芽组织。使用带有颅骨的硬脑膜颅骨成形术和用甲基丙烯酸树脂（Palacos）进行异体骨重建。术后四天，患者出院，一般情况良好。 GSF 是线性颅骨骨折的罕见并发症。估计发生率为所有颅骨骨折的 0.05%–1% [2,3,4]。大多数 GSF 发生在生命的前 3 年，但从围产期到成年都有记录 [1,3,4,5]。头部受伤和 GSF 诊断之间的间隔时间从 1 天到 1 年以上不等 [4, 6]。临床表现包括癫痫发作、局灶性神经功能缺损和意识丧失[3,4,5]。 GSF 的典型病理生理学特征定义为 (1) 线性颅骨骨折，间隙超过 4 毫米，(2)
Linear skull fractures in young children occasionally result in growing skull fractures. Neurosurgical correction of growing skull fractures (GSFs) by dural repair with cranioplasty is considered a safe and effective treatment with good prognosis. A 3-month-old boy fell from the stairs head first on to the floor. Initially he did not show any neurological symptoms. Craniography revealed a linear fracture of the right occipito-parietal skull bone. Cranial computer tomography showed a right-sided subdural haemorrhage, expanding beneath the fracture site, as well as contusion and swelling of the right hemisphere, leading to a modest midline shift. He was transferred to the paediatric intensive care unit for further evaluation and observation. After admission, he gradually lost consciousness and developed right-sided fixated eyes. Lowest EMV-scores were 1–4-T. Intracranial pressure, measured by an intraventricular probe, remained normal. Conservative treatment was chosen for the intracranial haemorrhage, and artificial ventilation and sedation was needed for 3 days. He developed a paresis and temporary focal epileptic activity of the left arm. This resolved over the months after discharge. Physical examination at 10 months of age (7 months after discharge) however revealed a soft pulsatile mass on the right occipito-parietal scalp. Bone ridges were felt around a discontinuum of the skull bone. Plain craniography showed a large occipito-parietal skull defect. Cerebral cranial magnetic resonance imaging revealed a cystic encephalomalacia, dilatation of the right ventricle and modest herniation of brain tissue into the skull defect (Fig. 1). Operative correction with both dural repair to resolve the herniation and cranioplasty to cover the dura and skull defect was performed. During surgery, the bone defect appeared to be covered with tissue which was later microscopically determined as granulation tissue. A dural cranioplasty with pericranium and alloplastic bone reconstruction with methacrylic resin (Palacos) was used. Four days post-surgery the patient was discharged in good general condition. GSFs are rare complications of linear skull fractures. Estimated incidence is 0.05%–1% of all skull fractures [2, 3, 4]. Most GSFs occur in the first 3 years of life, but are documented from perinatal period up to adulthood [1, 3, 4, 5]. Interval time between head injury and diagnosis of GSF varies from 1 day to more than 1 year [4, 6]. Clinical presentation includes seizures, focal neurological deficit and loss of consciousness [3, 4, 5]. Characteristic pathophysiological features of GSFs are defined as (1) linear skull fracture, gaping more than 4 mm,(2)