Growing skull fractures: classification and management

Seven patients with growing skull fractures treated between 1983 and 1993 are described. These growing fractures constituted 1.6% of all the cases of skull fractures seen during the period (a total of 449 cases). Based on aetiopathogenesis, computed tomography (CT) appearances, operative findings and management strategies required, three main types of growing skull fractures were recognized. In type I (n = 3) a leptomeningeal cyst, in type II (n = 3) damaged and gliotic brain, and in type III (n = 2) a porencephalic cyst extended through the skull defect into the subgaleal space. A combination of type I and type III co-existed in one patient. Initial head injury and neurological deficit were judged to be mild to moderate in all the seven cases. Continued growth of skull fractures correlated closely to the increasing neurological deficit in five cases. In two patients natural arrest of fracture growth at 5 and 7 months after trauma was accompanied by arrest in progress of neurological deficit. Available surgical options are discussed and general guidelines for the management are given.