Faculty Collaboration Database

Vacuum-assisted elevation of pediatric ping-pong skull fractures: a case series and technical note. J Neurosurg Pediatr 2020 Dec 25;27(3):325-334

Date

12/29/2020

Pubmed ID

33361480

DOI

10.3171/2020.7.PEDS2061

Scopus ID

2-s2.0-85102201707 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

OBJECTIVE: The management of children with ping-pong skull fractures may include observation, nonsurgical treatments, or surgical intervention depending on the age, clinical presentation, imaging findings, and cosmetic appearance of the patient. There have been 16 publications on nonsurgical treatment using negative pressure with various devices. Herein, the authors report their experience with vacuum-assisted elevation of ping-pong skull fractures and evaluate the variables affecting procedural outcomes.

METHODS: The authors performed a retrospective chart review of all ping-pong skull fractures treated via vacuum-assisted elevation at the Children's Hospital of Wisconsin between 2013 and 2017. Data collected included patient age, head circumference, mode of injury, time to presentation, imaging findings, procedural details, treatment outcomes, and complications.

RESULTS: Four neonates and 5 infants underwent vacuum-assisted elevation of moderate to severe ping-pong skull fractures during the study period. Modes of injury included birth-related trauma, falls, and blunt trauma. All patients had normal neurological examination findings and no evidence of intracranial hemorrhage. All fractures were deemed severe enough to require elevation by the treating neurosurgeon. All fractures involved the parietal bone. Skull depressions ranged from 23 to 62 mm in diameter and from 4 to 14 mm in depth. Bone thickness ranged from 0.6 to 1.8 mm. The time from fracture to intervention ranged from 7 hours to 8 days. The Kiwi OmniCup vacuum delivery system was used in all cases. Negative pressures were increased sequentially to a maximum of 500 mm Hg. A greater number of sequential vacuum applications was required for patients with a skull thickness greater than 1 mm at the site of depression and for those undergoing treatment more than 72 hours from fracture onset. Successful fracture elevation was attained in 7 of 9 patients. Two patients required subsequent surgical elevation of their fractures. Postprocedure imaging studies revealed no evidence of complications.

CONCLUSIONS: Increasing bone thickness and time from fracture onset to intervention appeared to be the greatest limiting factors to the successful elevation of moderate to severe ping-pong fractures via this vacuum-assisted approach. This procedure is a well-tolerated option that should be considered prior to performing an open repair in cases deemed to require fracture elevation. Future efforts will focus on larger-volume studies to better delineate inclusion and exclusion criteria, and volumetric analysis for better fracture-to-suction device customization.

Author List

Arocho-Quinones EV, Lew SM, Foy AB

Authors

Elsa V. Arocho-Quinones MD Assistant Professor in the Neurosurgery department at Medical College of Wisconsin
Andrew Foy MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin
Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Accidental Falls
Birth Injuries
Female
Humans
Infant
Infant, Newborn
Male
Neurosurgical Procedures
Parietal Bone
Postoperative Complications
Retrospective Studies
Skull Fracture, Depressed
Treatment Outcome
Vacuum
Wounds, Nonpenetrating