Growing skull fractures in a developing country: a case series

Abstract

Background: Growing Skull Fracture (GSF) is a very rare complication of skull fractures. Different types have been described and because presentation may be delayed with neurological sequelae, diagnosis and prompt intervention are key to achieving good outcome.
Objective: This study seeks to highlight the features and the technical peculiarities in management of growing skull fractures in low resource settings.
Methodology: A retrospective study of patients who were managed in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria, January 2006–October 2015. Relevant data were retrieved from patients’ medical records and analyzed.
Results: Seven patients were managed over the period under review, but complete records were found in only 4 cases. The age range was 6weeks- 48years, and 6 patients (85.7%) were in the paediatric age group (6weeks- 16months), with a mean age of 6.25months. All the paediatric patients were less than 2years of age. Three patients (42.9%) were females and four (57.1%) were males, giving a M: F ratio of 1.3:1. The aetiological factor in six of the patients (85.7%, all the paediatric cases) was road traffic accident. One patient (14.3%, the only adult) was assaulted, had a porencephalic cyst (type III GSF). One other patient had type-I GSF and was treated with cysto-peritoneal shunting, five had type-II GSF, four were managed operatively with craniotomy and duroplasty, while, one was lost to follow-up. Surgical outcomes were adjudged as good in all patients, but, anaemia was a problem in the paediatric patients.
Conclusion: Growing skull fracture is predominantly a disease of the paediatric age group which may, nevertheless, be seen in adults. Prompt and appropriate surgical intervention has a good outcome.

Keywords: Craniotomy, duroplasty, good outcome, surgical management