Growing skull fracture

Case contributed by Dalia Ibrahim


History of old trauma and surgical intervention for treatment of epidural hematoma. Bulging head swelling with progressive course since then.

Patient Data

Age: 7 years
Gender: Male
  • left parietal large calvarial defect
  • left temporo-parietal area of encephalomalacia underlying the fracture, sequel of old cerebral contusion
  • the left temporo-parietal area of encephalomalacia and adjacent leptomeninges are protruding through the large bone defect
  • right frontal area of encephalomalacia, sequel of old cerebral contusion (counter-coup)

Case Discussion

Leptomeningeal cysts, also known as growing skull fractures, are an enlarging skull fracture that occurs near post-traumatic encephalomalacia.

The exact pathogenesis remains unclear, but it is thought they occur secondary to skull fractures causing dural tears, allowing the leptomeninges and/or cerebral parenchyma to herniate into it. Pulsations from CSF erode the fracture margin, resulting in eventual expansion and non-union.

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