Background

Growing skull fracture (GSF) is a rare condition that may complicate pediatric head trauma. Patients may present with delayed-onset neurological manifestations.

Aim

This study aims to highlight the different presentations, methods of evaluation, treatment modalities, and outcomes in patients with orbital roof GSF.

Methods

This retrospective multicentric cohort study reviewed the hospital records of children with GSF who presented at the Craniomaxillofacial Plastic Surgery Department, and Neurosurgery Department with Otorhinolaryngology Department (Maxillofacial unit), from 2011 to 2020. The collected data included age, gender, delay, manifestations, findings of imaging techniques, surgical treatment, complications, and satisfaction of patients’ parents.

Results

Twenty-eight patients with orbital roof GSF were included in this study. Most of the patients (82.1%) were boys, and the mean (SD) age was 5 (2) years old. Head trauma was caused by falls in all cases. Clinical manifestations included eyelid swelling (75%), pulsatile proptosis (25%), headache (17.9%), and seizures (10.7%). The mean (SD) diameter of bony defects was 24.3 (8.7) mm. Duraplasty alone was performed in 57.1%, while dura-cranioplasty was done in 42.9% of patients. Dural reconstruction was done using pericranial graft in 82.1% and artificial grafts in 17.9% of patients. Most of the parents (95%) were absolutely satisfied. No mortalities or recurrence of symptoms were recorded. The median follow-up period after surgery was 3.9 years.

Conclusion

Orbital roof GSF should be considered among the differential diagnoses in pediatric patients with history of head trauma presenting with ocular and/or neurological manifestations. Duraplasty is mandatory in all cases, whereas cranioplasty is required mainly in cases with large bony defects more than 25 mm. Prognosis in most patients was good both subjectively and objectively.

中文翻译：

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眶顶颅骨骨折生长：28 例患者的多中心经验

背景

生长性颅骨骨折 (GSF) 是一种罕见的疾病，可能会使儿科头部创伤复杂化。患者可能出现迟发性神经系统表现。

目标

本研究旨在强调眶顶 GSF 患者的不同表现、评估方法、治疗方式和结果。

方法

这项回顾性多中心队列研究回顾了 2011 年至 2020 年在颅颌面整形外科和神经外科与耳鼻咽喉科（颌面科）就诊的 GSF 儿童的医院记录。收集的数据包括年龄、性别、延迟、表现、影像学检查结果、手术治疗、并发症和患者父母的满意度。

结果

本研究纳入了 28 名眶顶 GSF 患者。大多数患者 (82.1%) 为男孩，平均 (SD) 年龄为 5 (2) 岁。在所有情况下，头部外伤都是由跌倒引起的。临床表现包括眼睑肿胀 (75%)、搏动性突眼 (25%)、头痛 (17.9%) 和癫痫发作 (10.7%)。骨缺损的平均 (SD) 直径为 24.3 (8.7) 毫米。57.1% 的患者单独进行了硬脑膜成形术，而 42.9% 的患者进行了硬脑膜颅骨成形术。82.1% 的患者使用颅周移植物进行硬脑膜重建，17.9% 的患者使用人工移植物进行硬脑膜重建。大多数家长（95%）非常满意。没有死亡或症状复发的记录。术后中位随访时间为 3.9 年。

结论

眶顶 GSF 应考虑在有头部外伤病史并出现眼部和/或神经系统表现的儿科患者的鉴别诊断中。在所有情况下都必须进行硬脑膜成形术，而颅骨成形术主要用于骨缺损大于 25 毫米的情况。大多数患者的预后在主观和客观上都很好。