Use of magnetic resonance imaging to identify the edge of a dural tear in an infant with growing skull fracture: a case study.

PURPOSE: Growing skull fractures can be a challenging surgical problem facing pediatric neurosurgeons. The goal of this manuscript was to describe an effective surgical method used to treat a growing skull fracture.

METHODS

We present a case study of a 2-month-old boy who fell from his mother's arms and hit his head on the floor; he underwent X-ray, magnetic resonance (MR), and computed tomography (CT) imaging before cranioplasty with dural plasty.

RESULTS

X-ray performed on admission revealed a diastatic fracture with a gap of 8 mm in the right frontal bone and a linear fracture in the right occipital bone. X-ray performed 37 days after injury demonstrated that the gap had increased to 25 mm, and the patient was diagnosed with a growing skull fracture of the right parietal bone. Cranioplasty with dural plasty was performed on day 39. A combination of MR and CT images enabled the edge of the dural tear to be plotted on a three-dimensional image of the skull, and this was used to estimate the location of the edge of the dural tear on the scalp.

CONCLUSIONS

We achieved excellent outcomes in terms of bony coverage and dural plasty. The combination of MR and CT images may be recommended for surgical repair of growing skull fracture in children.