Growing skull fracture: Delayed presentation, surgical management, and review of the literature

Background: Growing skull fracture (GSF), also known as post-traumatic leptomeningeal cyst, is a rare late complication of a linear skull fracture in young children. It requires an underlying dural tear with progressive herniation of arachnoid membrane and/or brain tissue. Case Description: We report a 15-month-old child who sustained a right frontoparietal linear skull fracture at 1 month of age and returned 14 months later with a pulsatile scalp swelling and left hemiparesis. Computed tomography showed a wide right frontoparietal diastasis and adjacent ventricular dilatation. At surgery, the 10 × 3 cm defect was densely adherent to the arachnoid and ependymal surface. Adhesiolysis and watertight galeal duraplasty were performed, and the bone flap was replaced. The findings were most consistent with Naimur-Rahman type III GSF. Motor function recovered almost completely by 6 months, while follow-up at 6 and 12 months showed partial closure of the residual osseous gap. Conclusion: GSF should be suspected when delayed scalp swelling or neurological deficits follow an infant skull fracture. Selective follow-up of high-risk fractures and timely watertight dural repair can limit progressive morbidity.