Amaresh, Balasubramanya

---

Most skull fractures in childhood heal without sequelae. Rarely the fracture site starts widening with time and appears to be growing & is thus called Growing Skull Fracture. Its late complication is called Leptomeningeal cyst, which is practically a cerebromeningeal cicatrix with loculated CSF. Almost all cases reported are following Headtrauma from RTA's or fall. We report a case of Leptomeningeal cyst following monkey bite.

A 3 year old female child was brought with one year history of slowly growing swelling over her left frontal region. There was a history of adult monkey bite in the same region 2 years earlier. X-ray skull showed a linear skull fracture at that time.

On Examination, the child was fully conscious and neurologically stable. A huge cystic swelling (9cm x 6cm) over right frontal region with central healed scar was seen.

C.T. Scan showed Leptomeningeal cyst with thick everted bony margins. A piece of bone was seen at the centre of the Cyst, which was probably a free bone fragment detached at the time of monkey bite along with CSF and Cerebromeningeal cicatrix.

The child underwent exploration, excision of cicatrix and sequestrum, duraplasty and cranioplasty using autologous rib.

Transient progression & subsequent spontaneous healing of neonatal Diastatic fractures have also been reported. The purpose of surgical management is to present sequelae like neurological deterioration, seizure disorder & cerebromeningeal cicatrix.

Growing skull fracture following animal bite has not been reported earlier. This same case report was published in the Indian Journal of Neurotrauma Vol. 2 in 2005.