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Spontaneous intrauterine depressed skull fractures (IDSF) are rare fractures that often require neurosurgical evaluation and therapy. The majority of reported congenital depressions are secondary to maternal abdominal trauma or instrumentation during delivery. Spontaneous IDSF occur in the setting of uneventful normal spontaneous vaginal delivery (NSVD) or cesarean section, without obvious predisposing risk factors. The etiology and optimal management of spontaneous IDSF remain controversial.We describe 2 cases of spontaneous IDSF that underwent cranioplasty at our institution using an absorbable mesh, as well as review the current state of knowledge regarding the diagnosis and management of spontaneous IDSF. The 2 neonates, 1 male and 1 female, presented at Lucile Packard Children's Hospital with spontaneous IDSF after uneventful NSVDs. The fractures were located in the left frontal and right parieto-temporal calvarium, respectively. Both patients underwent open craniotomy and elevation of their IDSF with mesh cranioplasty. At last follow-up, both patients were normocephalic and neurologically intact.Neurosurgery consultation is necessary for initial evaluation of spontaneous IDSF. Surgical intervention is indicated for larger defects and/or intracranial involvement. Expectant management and negative-pressure elevation have also been shown to be effective.
View details for DOI 10.1016/j.wneu.2017.10.029
View details for PubMedID 29051109