Pediatric Skull Fracture Characteristics Associated with the Development of Leptomeningeal Cysts in Young Children after Trauma: A Single Institution's Experience

Background:Currently, the pathogenesis of leptomeningeal cysts, also known as growing skull fractures, is still debated. The purpose of this study was to examine the specific skull fracture characteristics that are associated with the development of growing skull fractures and describe the authors' institutional experience managing this rare entity.Methods:A retrospective cohort study was performed that included all patients younger than 5 years presenting to a single institution with skull fractures from 2003 to 2017. Patient demographics, cause of injury, skull fracture characteristics (e.g., amount of diastasis, linear versus comminuted fracture), concomitant neurologic injuries, and management outcomes were recorded. Potential factors contributing to the development of a growing skull fracture and neurologic injuries associated with growing skull fractures were evaluated using univariate logistic regression.Results:A total of 905 patients met the authors' inclusion criteria. Of these, six (0.66 percent) were diagnosed with a growing skull fracture. Growing skull fractures were more likely to be comminuted (83.3 percent versus 40.7 percent; p = 0.082) and to present with diastasis on imaging (100 percent versus 26.1 percent; p < 0.001; mean amount of diastasis, 7.1 mm versus 3.1 mm; p < 0.001). Univariate logistic regression analysis confirmed the role of a comminuted fracture pattern (OR, 7.572) and the degree of diastasis (OR, 2.081 per mm diastasis) as significant risk factors for the development of growing skull fractures.Conclusions:The authors' analysis revealed that fracture comminution and diastasis width are associated with the development of growing skull fractures. The authors recommend dural integrity assessment, close follow-up, and early management in young children who present with these skull fracture characteristics.

背景：目前，软脑膜囊肿（又称生长性颅骨骨折）的发病机制仍存在争议。本研究的目的是检查与生长性颅骨骨折发展相关的特定颅骨骨折特征，并描述作者所在机构处理这种罕见病症的经验。 方法：进行了一项回顾性队列研究，纳入了2003年至2017年期间在一家机构就诊的所有5岁以下颅骨骨折患者。记录患者的人口统计学资料、损伤原因、颅骨骨折特征（例如，分离程度、线性骨折还是粉碎性骨折）、伴随的神经损伤以及治疗结果。使用单因素逻辑回归评估导致生长性颅骨骨折发展的潜在因素以及与生长性颅骨骨折相关的神经损伤。 结果：共有905名患者符合作者的纳入标准。其中，6名（0.66%）患者被诊断为生长性颅骨骨折。生长性颅骨骨折更有可能是粉碎性的（83.3%对40.7%；p = 0.082），并且在影像学上表现出分离（100%对26.1%；p < 0.001；平均分离程度为7.1毫米对3.1毫米；p < 0.001）。单因素逻辑回归分析证实了粉碎性骨折模式（比值比为7.572）和分离程度（每毫米分离的比值比为2.081）是生长性颅骨骨折发展的重要危险因素。 结论：作者的分析表明，骨折粉碎程度和分离宽度与生长性颅骨骨折的发展相关。作者建议对具有这些颅骨骨折特征的幼儿进行硬脑膜完整性评估、密切随访以及早期治疗。