One more indication for surgery in acute head injury in children

EvImages ery neurosurgical centre has been operating children with sizeable extradural, subdural  ,intracerebral haemotomas and compound skull fractures. Sometimes a simple depressed fracture also needs surgery for cosmetic reasons. In uncontrolled intracranial pressure , a decompressive surgery is also often practiced.

However standard text books and many protocols do not include children with diastatic fractures with underlying dural and arachnoid tears. Since brain grows fast in first 5 years of life and children have a tendency to fall on head because of larger head to body ratio, any trauma to head which produces  wide skull fracture and may have dural and arachnoid tear with injury to brain. It is important that these possible growing skull fractures be tackled initially so that they do not suffer later from craniocerebral erosion.

Author has operated on large number of children who had intact scalp but had brain prolapsing out through dural and arachnoid tear. If left unattended progressive brain matter loss occurs in these children. Most of these patients have diastatic fracture in posterior frontal and frontoparietal regions and therefore these children have hemiparesis.

One such child is being operated today.
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This child has right parietal diastatic fracture and had large dural tear. There was no scalp laceration. Patient also had intracerebral haematoma. However indication to operate him was diastatic fracture with underlying dural and arachnoid tear.

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