The risk of growing skull fractures in craniofacial patients.

Pediatric neurosurgery

PubMedID: 20962552

Keshavarzi S, Meltzer H, Cohen SR, Breithaupt A, Ben-Haim S, Newman CB, Levy ML. The risk of growing skull fractures in craniofacial patients. Pediatr Neurosurg. 2010;46(3):193-8.
BACKGROUND/AIMS
Growing skull fractures (GSFs) are unusual sequelae of head injury in young children which have also been reported to occur after craniofacial procedures complicated by inadvertent durotomy. We reviewed the craniofacial experience in a single institution, detailing 180 cases of craniofacial surgery and suspected dural tears and their relationship to the subsequent development of GSFs. This experience was then compared to that of the pertinent published literature.

METHODS
A retrospective review of the senior authors' craniofacial surgical experience from 2000 to 2007 was performed. This was compared to an English-language literature review of GSFs after craniofacial surgery.

RESULTS
In our institution, 180 cases of craniofacial surgery (83 open, 97 endoscopic) were performed, with an average follow-up of 23.5 months. Twenty-five patients (15 open, 10 endoscopic surgeries) had operative dural compromise. One of these patients developed a persistent pseudomeningocele requiring reoperation. Twelve cases of GSF after craniofacial surgery were identified in a review of the English-language literature, of which 7 (58%) had coronal suture fusion.

CONCLUSIONS
While durotomy may occur during craniofacial surgery, the subsequent development of a GSF appears to be an unlikely event with an aggressive intraoperative approach of identification and repair. Coronal craniosynostosis may confer an increased risk for this complication.