Clinical and imaging characteristics of growing skull fractures in children.

Growing skull fracture (GSF) is an uncommon form of head trauma among young children. In prior research, the majority of GSFs were typically classified based on pathophysiological mechanisms or the duration following injury. However, considering the varying severity of initial trauma and the disparities in the time elapsed between injury and hospital admission among patients, our objective was to devise a clinically useful classification system for GSFs among children, grounded in both clinical presentations and imaging findings, in order to guide clinical diagnosis and treatment decisions. The clinical and imaging data of 23 patients less than 12 years who underwent GSF were retrospectively collected and classified into four types. The clinical and imaging characteristics of the different types were reviewed in detail and statistically analyzed. In all 23 patients, 5 in type I, 7 in type II, 8 in type III, and 3 in type IV. 21/23 (91.3%) were younger than 3 years. Age ≤ 3 years and subscalp fluctuating mass were common in type I-III (P = 0.026, P = 0.005). Fracture width ≥ 4 mm was more common in type II-IV (P = 0.003), while neurological dysfunction mostly occurred in type III and IV (P < 0.001).Skull "crater-like" changes were existed in all type IV. 10/12 (83.3%) patients with neurological dysfunction had improved in motor or linguistic function. There was not improved in patients with type IV. GCS in different stage has its unique clinical and imaging characteristics. This classification could help early diagnosis and treatment for GCS, also could improve the prognosis significantly.

Effects of parasagittal meningiomas on intracranial venous circulation assessed by the virtual reality technology.

OBJECTIVE: This study is to investigate the compensatory intracranial venous pathways in parasagittal meningiomas (PSM) patients by virtual reality technology. METHODS: A total of 48 PSM patients (tumor group) and 20 patients with trigeminal neuralgia and hemifacial spasm but without intracranial venous diseases (control group) were enrolled. All patients underwent 3D CE-MRV examination. The 3D reconstructed images by virtual reality technology were used for assessment of diameter and number of intracranial veins, tumor location, venous sinus invasion degree and collateral circulation formation. RESULTS: Diameter of bridging veins in posterior 1/3 superior sagittal sinus (SSS) in tumor group was significantly smaller than that of the control group (P < 0.05). For tumors located in mid 1/3 SSS, diameter of bridging veins and vein of Labbé (VL) in posterior 1/3 SSS decreased significantly (P < 0.05). For tumors located in posterior 1/3 SSS, bridging vein number and transverse sinus (TS) diameter significantly decreased while superficial Sylvian vein (SSV) diameter increased significantly (P < 0.05). Compared with tumor in posterior 1/3 SSS subgroup, number of bridging veins in the tumor in mid 1/3 SSS subgroup increased significantly (P < 0.05). Compared with control group, only the bridging vein number in anterior 1/3 SSS segment in invasion Type 3-4 tumor subgroup decreased significantly (P < 0.05). Diameter of TS and bridging veins in posterior 1/3 SSS segment in sinus invasion Type 5-6 tumor subgroup decreased significantly (P < 0.05). Compared with control group, only the diameter of VL and TS of collateral circulation Grade 1 tumor subgroup decreased significantly (P < 0.05) while in Grade 3 tumor subgroup, TS diameter decreased and SSV diameter increased significantly (P < 0.05). CONCLUSIONS: The intracranial blood flow is mainly drained through SSV drainage after SSS occlusion by PSM.

Guidance value of intracranial venous circulation evaluation to parasagittal meningioma operation.

OBJECTIVE: This study is to investigate the value of intracranial venous circulation evaluation in guiding the surgery for parasagittal meningioma. METHODS: A total of 44 parasagittal meningioma (PSM) patients received 3D CE-MRV scanning. The obtained images were reconstructed by virtual reality (VR) technology. Venous collateral circulation was evaluated. Postoperative follow-up was carried out. RESULTS: Among 44 PSM patients, 41 cases were with resection of Simpson grade I/II (93.18%) and 6 cases were with permanent neurological dysfunction (13.64%). Venous sinus thrombosis occurred in the remaining 3 patients (6.82%), with 2 cases cured and 1 case died. The mortality rate was 2.27%. Recurrence occurred in one case (2.27%) after discharge. In 9 cases, tumor adjacent SSS was transected and the poor prognosis rate was 33.33%. SSS was opened in 3 cases and after removal of the tumor the broken end was sutured directly. The poor prognosis occurred in one case (33.33%). Electrocoagulation was carried out to the SSS wall in 32 cases without opening venous sinus and 2 cases were with poor prognosis (6.25%). The three different venous sinus treatment methods had no significantly difference on the prognosis of patients (P > 0.05). CONCLUSIONS: Preoperative evaluation of intracranial venous circulation with VR technology and 3D CE-MRV may help making individual surgical plans, reduce venous injury and improve the prognosis of PSM patients.