Acute Identification of Cranial Burst Fracture: Comparison between CT and MR Imaging Findings
Thomas S. Ellisa,
L. Gilbert Vezinaa and
David J. Donahue
,a
a From the Departments of Neurosurgery (T.S.E., D.J.D.) and Radiology (L.G.V.), Children's National Medical Center, The George Washington University Medical Center, Washington, DC.
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FIG 1. Patient 1.
A, Skull radiograph 4 hours after injury shows a widely diastatic right frontal skull fracture.
B, CT scan of acute cranial burst fracture 4 hours after injury shows hemorrhagic contusion beneath the fracture, overlying scalp swelling, and moderate eversion of fracture edges.
C and D, Axial T2-weighted (3000/100/1) (C ) and sagittal T1-weighted (549/20) (D) MR images 15 hours after injury show acute transcalvarial brain herniation. Brain parenchyma is clearly differentiated from scalp soft tissue and hematoma. Note associated convexity and interhemispheric subdural hematoma and cortical contusions.
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FIG 2. Patient 3.
A, Axial CT scan 3 hours after injury shows diastatic fracture with everted fracture edge and marked scalp swelling. Underlying subdural and subarachnoid hemorrhage and small cortical contusion are present.
B, Coronal T2-weighted (3500/108/1) MR image 36 hours after injury reveals extent of cerebral herniation and dural defect. Note high signal intensity of both intracranial and extracranial brain tissue.
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FIG 3. Patient 6.
A, CT scan of fatal cranial burst fracture 2 hours after injury shows diastasis of coronal suture, bifrontal cortical contusions, and marked, high-density scalp swelling.
B, Coronal T2-weighted (3000/108/1) MR image 12 hours after injury reveals transdural herniation of hemorrhagic brain and cortical vessels with underlying cortical contusions.
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FIG 4. Intraoperative photograph of patient 1. The cerebral cortex is encountered in the subgaleal plane after scalp incision.FIG 5. Operative appearance of growing skull fracture that remained untreated for 6 months after injury. A sizable defect has developed, necessitating large dural and split-thickness calvarial grafts. Acutely treated cranial burst fractures rarely require grafts of either skull or dura
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