Congenital depressed skull fracture in the absence of trauma: case report and literature review

Zulma S Tovar-Spinoza, Peter D Kim

Department of Neurosurgery, SUNY Upstate Medical University, Syracuse NY

Abstract: There are limited reports of neonatal depressed skull fractures in the absence of any known trauma or obvious risk factors. Here we describe a male neonate with a significant frontal nontraumatic depressed fracture, his course of treatment, and a literature review. A male neonate was attended for a significant congenital depressed skull fracture in the left frontal bone. He was born full term after an uncomplicated delivery to a multiparous mother who was a human immunodeficiency syndrome (HIV)-positive immigrant from sub-Saharan Africa. The pregnancy was otherwise uncomplicated. There was no history of trauma to the mother during the pregnancy or delivery. Ultrasonography had been unremarkable. No other abnormalities were noted. The patient was brought to the operating room at the age of 13 days for elevation of his fracture due to its nonreducible nature. A small linear incision was made just posterior to the coronal suture. The dura mater was stripped and a combination of Penfield and periostial elevators was used to elevate the depressed fracture. Nontraumatic depressed skull fractures are uncommon in neonates. The cause of this entity has not been identified, and many theories about its origin have been proposed. Treatment can be either surgical or conservative.

Keywords: neonatal, congenital, depressed fracture, spontaneous, nontraumatic