Author/Editor		Strojnik, Tadej; Pogorevc, Robert
Title		Rastoča fraktura lobanje - prikaz primera in pregled literature
Translated title		Growing skull fracture - case report and review of the literature
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 73, št. 4
Publication year		2004
Volume		str. 269-74
Language		slo
Abstract		Background. Growing skull fracture is a progressive enlargement of a fracture. It produces a cranial defect. It is a rare complication of head injury, occurring almost exclusively in infants and children under the age of three. It rarely occurs latter than 6 months from the injury. This condition requires both a widely separated fracture and a dural tear. Most growing skull fractures are brought to medical attention when the palpable mass is noticed. If left untreated it might lead to neurological deficit and/or epilepsy. MR combined with CT scan and plain skull X-rays is and indispensable procedure for diagnosis of growing skull fracture. Treatment is surgical with dural closure mandatory. Patient and methods. A 10-month-old male infant felt down stairs and suffered a blow in his right parietal region. On admission, he was conscious with Children Coma Scale Score (CCS) 11. He had no neurological deficits. Skull X-ray just after the injury showed a diastatic right parietal skull fracture about 5 mm in diameter spreading from lambdoid toward the sagittal suture. CT scan upon admission revealed the above mentioned fracture line but no brain contusion. Ten days later, he was discharged home. Repeated sk.ull films revealed growth of a fracture line. 3D CT demoustrated a growing skull fracture. MR revealed cortical atrophy, cystic lesion beneath the bone defect and subgaleal cerebral herniation. He was operated 7 months after injury. A dural reconstruction with the periost graft and a cranioplasty with titanium mesh were performed. The postoperative course was uneventful except one seizure. After 2 weeks, he was discharged with no neurological deficit Conclusions. This entity consists of a skull fracture with an underlying dural tear those courses with a progressive enlargement of the fracture to produce a cranial defect. Physiologic growth of the brain contributes to the fracture enlargement. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Rastoča fraktura lobanje pomeni progresivno večanje frakture, ki vodi v okvaro lobanje. Gre za zelo redek zaplet poškodbe glave in možganov (PGM), ki nastopi skoraj izključno pri dojenčkih in otrocih do 3 let starosti. Redko se pojavi kasneje kot 6 mesecev po poškodbi. Poleg frakture je tudi raztrganina dure. Najpogosteje se odkrije zaradi nastanka tipne gmote pod skalpom. Nezdravljena vodi do nevrološkega deficita in/ali epilepsije. Za diagnozo je najbo jša magnetna resonanca (MR) v kombinaciji z računalniško tomografijo (CT) in rentgenogramom (RTG) lobanje. Zdravljenje je kirurško. Potrebna je kraniotomija in rekonstrukcija dure. Bolniki in metode. Deček se je v starosti 10 mesecev skotalil po stopnicah in utrpel diastatsko frakturo temenske kosti na desni strani. Frakturna poka ravnih robov, ki je merila do 5 mm v širino, je segala od lambdoidnega pa skoraj do sagitalnega šiva. Ob sprejemu je bil ocenjen po otroški lestvici nezavesti (CCS) z 11. Nevroloških izpadov ni imel. Zdravljen je bil konzervativno. CT glave razen frakturne poke posebnosti ni pokazal. Deseti dan je bil odpuščen v domačo oskrbo. Ambulantno smo ga skrbno spremljali in na dva meseca ponavljali RTG lobanje. Posnetki so pokazali, da se frakturna poka desne temenske kosti veča. Postavili smo sum na rastočo frakturo lobanje (RFL). Napravili smo še tridimenzionalni CT in MR preiskavo glave. Prva je pokazala obsežno rastočo frakturno poko v desnem temenskem področju. Na MR pa je bilo videti še kortikalno možgansko atrofijo. V frakturno poko je bila izbočena možganovina, vidna pa je bila tudi leptomeningealna cista. Odločili smo se za nevrokirurško operativno zdravljenje. Sedmi mesec po poškodbi smo napravili desno temensko kraniotomijo in napravili rekonstrukcijo dure s periostalnim režnjem. Okvaro lobanje smo krili s titanijevo mrežico. V pooperativnem poteku, razen enega epileptičnega napada takoj po operaciji, ni bilo posebnosti. (Izvleček skrajšan pri 2000 znakih).
Descriptors		SKULL FRACTURES PARIETAL BONE FRACTURE HEALING DURA MATER CRANIOTOMY INFANT TOMOGRAPHY, X-RAY COMPUTED MAGNETIC RESONANCE IMAGING ARACHNOID CYSTS BRAIN INJURIES