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Background: Delayed swelling after skull fractures is an uncommon complication following head trauma in children. Classically, growing skull fractures typically present in patients under 3 years of age with progressive subcutaneous fluid collections, or occasionally with neurologic symptoms. We present the case of a healthy 2-year-old boy with a lytic 'punched-out' frontal skull lesion. The child presented 2 months after a minor forehead injury for which no medical attention was sought. Methods: The skull defect had no associated leptomeningeal cyst or brain herniation. Imaging and presentation were thought to be consistent with eosinophilic granuloma. Histologic findings demonstrated a healing skull fracture. Results: Cranioplasty was performed, and the patient had an uncomplicated postoperative course. Conclusions: In this report, we describe our experience with this atypical presentation of a healing skull fracture mimicking a typical eosinophilic granuloma. [ABSTRACT FROM AUTHOR]

A trend in large myelomeningocele defect repair involves soft tissue closure with muscle and fascial flap techniques to provide a durable, protective, and tension-free soft tissue covering. We propose that composite tissue closure yields superior outcomes regardless of defect size. We present a retrospective review of our 15-year, single-institution experience using this approach. Our study includes 45 consecutive patients treated using combinations of muscle and fascia flaps for primary closure of a myelomeningocele defect. Lumbosacral fascia closures were used in 18 cases (40%) with paraspinous muscle closure and 12 cases (27%) without paraspinous closure. Fascial closure with bony pedicle periosteum and gluteal muscle and fascial closure were used in four cases (9%) each. Other techniques included latissimus dorsi flaps and combinations of these techniques. Postoperatively, none of our patients experienced a cerebrospinal fluid leak, and only one patient required reoperation for skin flap necrosis. Objective measures show that universal application of flap techniques may lead to better outcomes for soft tissue closure during myelomeningocele repair. [ABSTRACT FROM AUTHOR]

Purpose: Craniocervical arterial dissections (CCADs) represent a preventable cause of acute ischemic stroke (AIS). Our objective was to describe clinical presentation, imaging features, treatment strategies, and report clinical and imaging outcomes of CCADs at a large pediatric tertiary referral center. Methods: Electronic medical records were queried using variations of the word dissection for patients under 25 years of age with neuroimaging over a 13-year period. Medical and imaging records were reviewed to identify carotid, vertebral, or intracranial dissections. Demographics, presenting symptoms, presence of AIS, mechanism of injury, dissection location, dissection treatment, and complications stemming from treatment were collected. Clinical outcome was classified according to modified Rankin Scale (mRS) score. Imaging follow-up was obtained until the dissection healed or stabilized. Results: A total 6,289 patients met initial search criteria. Of the 42 (0.7 %) patients with CCADs, 23 (54.8 %) had internal carotid artery (ICA) dissections, and 17 (40.5 %) had vertebrobasilar (VB) dissections. More females had ICA dissections ( p = 0.002), and more males had VB dissections ( p = 0.01). CCADs associated with traumatic presentation occurred in 34 patients (81.0 %), while 8 (19.0 %) were spontaneous. Good outcomes (mRS 0-3) were noted for 36 patients, and 5 had poor outcomes (mRS 4-6). In the 17 patients with vessel occlusion, 50.0 % had partial or complete recanalization at a mean follow-up of 23.9 months. Conclusions: CCAD is commonly related to trauma and presents with AIS. The majority of patients experience good clinical outcome. Recanalization of initial vessel occlusion occurs in half of cases at 2 years. [ABSTRACT FROM AUTHOR]

Objective: Arteriovenous malformations (AVMs) are the most frequently encountered structural cause of spontaneous intracerebral hemorrhage in childhood, excluding hemorrhages of prematurity. The goal of our study was to examine the relationship between age and AVM prevalence on imaging in children, which to date has not been well described. Methods: We queried the electronic and radiographic records of 14,936 consecutive patients aged 25 years or less who had undergone brain magnetic resonance imaging (MRI) at a single institution over an 11-year period to identify those with a cerebral AVM. We collected age, gender, and other demographic characteristics for all patients. For all patients with a cerebral AVM, we recorded the location, size, drainage pattern, Spetzler-Martin grade, medical history, and presence of neurological symptoms. Results: Cerebral AVMs were identified in 55 patients (0.37%). The prevalence of AVMs detected on MRI significantly increased with age ( p = 0.001). AVMs were found in 0.34% of boys (25 of 7,447) and 0.40% of girls (30 of 7,489). AVMs were most commonly identified in the frontal lobes (36%), followed by parietal (20%) and temporal lobes (13%). Sixty percent ( n = 33) of AVMs were less than 3 cm in size, 35% ( n = 19) were 3-6 cm in size, and 5.5% ( n = 3) were greater than 6 cm in size. As for Spetzler-Martin grade of the AVMs, 25.5% were grade I, 18.2% were grade II, 36.4% were grade III, 16.4% were grade IV, and 3.6% were grade V. Conclusions: AVMs are seen more frequently on MRI with advancing age in children and young adults. [ABSTRACT FROM AUTHOR]