The principles of pediatric neurosurgery were meticulously and carefully followed when approaching growing skull fracture repair. The use of magnetic resonance imaging (MRI) studies in cases with growing fractures has changed our understanding of pathogenesis and surgical management of this lesion. Owing to the risk of neurological deterioration and development of seizure disorders, surgical correction of growing fractures is recommended by craniectomy and repair. These support dural tear as being the major risk factor in the development of a growing skull fracture. In addition, craniotomies performed without watertight closure of dural lacerations have been found to lead to growing skull fractures. This dilatation is said to be reversible and may normalize after surgical repair. The brain extrusion may be present shortly after diastatic linear fracture in neonates and young infants resulting in focal dilation of the lateral ventricle near the growing fracture. The resorption of the adjacent bone by the continuous pressure from tissue herniation through the bone gap adds to the progression of the fracture line. This interposition of tissue prevents osteoblasts from migrating to the fracture site and inhibiting healing. The pulsatile force of the brain during its growth causes the fracture in the thin skull to enlarge. Although the development of growing skull fractures is multifactorial, the predominant factor in their causation is the presence of lacerated dura mater. The incidence reported is only 0.05%–0.1% of skull fractures in childhood. Growing skull fracture is a rare complication of head injury in childhood.
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