Growing skull fracture of the orbital roof. Case report

Growing skull fractures are rare complications of head trauma and very rarely arise in the skull base. The clinical and radiological finding and treatment of a growing fracture of the orbital roof in a 5-year-old boy are reported, and the relevant literature is reviewed. The clinical picture was eyelid swelling. Computed tomography (CT) scan was excellent for demonstrating the bony defect in the orbital roof. Frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing skull fracture of the orbital roof should be considered in the differential diagnosis in cases of persistent ocular symptoms. Craniotomy with excision of gliotic brain and granulation tissue, dural repair and cranioplasty is the treatment of choice.     

Agenesis of the skull bones

 Agenesis of the cranial bones, a rare condition usually incompatible with life, was seen in a neonate. Embryogenesis and management of the condition are discussed. The defect heals with conservative treatment. Accepted: 9 May 2000     

Unusual osteoblastoma of the skull

Benign osteoblastoma is a rare primary bone tumor, the location in the frontal bone being particularly rare (only a few cases described). The youngest age of occurrence reported is 3 years. We present a case of osteoblastoma occurred in a 4 1/2-month-old boy, located in the frontal bone.     

Tuberculous osteitis of the skull

A case of tuberculous osteitis of the skull associated with progressive pulmonary tuberculosis is described. The literature is reviewed in brief.     

Tuberculosis of the ischium

A case of ischial tuberculosis in a 6-yr-old boy is reported. Paratracheal lymphadenopathy was present along with the bone lesion. This is a very uncommon location for tuberculous involvement especially in children.     

Tuberculosis of the patella

The case of an 8-year-old boy with tuberculous arthritis of the right knee in whom patellar disease was the only radiological abnormality is presented. The patellar findings were a large lytic area with sclerotic borders containing a dense image corresponding to a sequestrum. Open biopsy was necessary for diagnosis, since the radiological abnormalities are consistent with other chronic infectious diseases.     

Massive osteolysis of the skull base

Gorham's vanishing bone disease is a rare disorder characterized by massive osteolysis. Its etiology is unknown. We report the case of a 14-year-old girl with an unusually aggressive course and extensive involvement originating within the skull base. To our knowledge this pattern has not been described previously. MR findings are discussed. Received: 10 January 1996 Accepted: 3 July 1996     

新生儿硬膜外血肿伴颅骨骨折及头颅血肿治疗方法初探

目的 探讨新生儿硬膜外血肿伴颅骨骨折及头颅血肿时通过头颅血肿穿刺抽血对硬膜下血肿的治疗效果。方法 对2012—2013年我科收治的4例新生儿硬膜外血肿伴颅骨骨折及头颅血肿患儿的临床表现、影像学特点进行总结;患儿均行床旁抽取头颅血肿内的血液治疗颅内硬膜外血肿。对比患儿手术前后的影像学改变,并对患儿进行随访。结果 4例硬膜外血肿患儿均有头颅血肿和颅骨骨折。2例临床无神经系统异常表现,其中1例生后头颅血肿进行性增大;1例患儿有神经兴奋症状;1例患儿生后21 h出现惊厥,生后6天仍有肌张力减低。4例患儿影像学均发现在头颅血肿对应颅内部位有硬膜外血肿并对周围脑皮质有不同程度压迫,在头颅血肿和硬膜外血肿之间的颅骨存在骨折。4例患儿分别于生后3~9天行头颅血肿穿刺,抽出血量3~24 ml不等,手术后硬膜外血肿均明显减小,其中1例抽过两次头颅血肿。2例患儿已随访1年,2例患儿随访3个月;其中3例患儿神经发育同同龄儿,1例因肌张力减低进行康复治疗,已明显好转。结论 对于伴颅骨骨折及头颅血肿的硬膜外血肿,可行头颅血肿穿刺,通过骨折缝隙将颅内硬膜外血肿的血液引流至颅外头颅血肿处,减小硬膜外血肿,达到减轻对脑实质的压迫及减少神经系统后遗症的目的。     

儿童颅骨嗜酸性肉芽肿

目的 探讨颅骨嗜酸性肉芽肿的临床表现、诊断和治疗.方法 对2003年1月至2010年12月间我科收治的儿童颅骨嗜酸性肉芽肿48例进行回顾性分析.所有病例术前均行头颅CT检查,其中12例行头颅MRI检查,均行长骨和扁骨的X线片检查,均行手术治疗和病理检查.结果 顶骨为好发骨.1例多发,1例合并锁骨病变.所有病例均行手术全切,术后均未行放疗.15例因局部硬脑膜、帽状腱膜受浸,术后应用吲哚美辛治疗6周.随访6个月至7年(平均3.2年),均无复发.结论 颅骨嗜酸性肉芽肿为良性病变,在诊断时需警惕多发病灶.手术切除是单发病灶的最佳治疗方法,术后不需要侵袭性化疗和放疗,预后好.     

Tubercular osteomyelitis of skull

Two cases of tuberculous oeteomyelitis of the skull bones have been reported. The first case presented with swelling on right frontoparietal region and punched out osteolytlc lesion in the frontal bone. The second case presented as diabetes insipidus, without any obvious swelling on scalp and skiagram of skull revealed osteolytic lesion in frontoparietal region with shallow widened pituitary fossa. Both the cases improved on antitubercular drugs along with thiazides in second case for diabetes insipidus.