PSEUDOMENINGOENCEPHALOCELES (GROWING SKULL FRACTURES) AFTER CRANIOSYNOSTOSIS REPAIR

Abstract

Growing skull fracture (GSF) is also termed as cranio-cerebral erosions, leptomeningeal cyst, cephalohydrocoele, traumatic meningocele, meningocele spuria and   pseudoencephalocele. It occurs in 1% of linear skull fractures. 90% of patients are below the age of 3 years and 50% of patients are below the age of 1 year. The condition is rare after the age of 3 years. Growing skull fractures commonly involved calvarial bones. Etiologies include fall, vehicular accident and child abuse. Rare causes are corrective surgeries for craniosynostosis and following difficult vacuum extraction and after burr hole placement. An important factor in its pathogenesis is a skull fracture with its dural tear and entrapment of arachnoid membrane and brain tissue within fracture margin. Till now only 9 reports of GSF after corrective surgery for craniosynostosis have been reported. We report a case of an 11 -month old male child, a known case of Crouzen’s syndrome who was operated previously for craniosynostosis by bifrontal craniotomy, fronto-orbital advancement and right frontal ventriculo-peritoneal (VP) Shunting. He presented with multiple extracranial lobulated soft tissue swellings. Computed tomography of the brain showed dilatation of both lateral ventricles. Cranial vault was deformed in shape due to craniosynostosis. Copper beaten skull suggestive of raised intracranial tension was noted. Multiple defects were noted in the cranial vault in bilateral fronto-parietal regions through which herniation of CSF filled structures were noted suggestive of pseudomeningoceles.