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Treatment of depressed skull fractures with vacuum devices in the neonatal period: A case series

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Abstract

Purpose

The management of depressed skull fractures in infants can be either conservative or surgical. This study aimed to examine the outcomes of management with a negative-pressure vacuum device on depressed skull fractures in newborns.

Methods

Twenty-eight patients (aged 1–6 days) with simple depressed skull fractures underwent skull elevation using negative-pressure vacuum devices. A protocol for nonsurgical management was adopted for infants with such fractures between 2010 and 2023. All patients were initially evaluated with neurological examination and complementary assessments—hematological and coagulation studies, transfontanel transcranial ultrasound, skull radiography, and computed tomography scanning with three-dimensional reconstruction—according to availability and clinical needs. Gentle (negative) extraction pressure was applied with one of several devices (according to institutional availability) for a maximum duration of 60 s; this was performed as soon as possible after diagnosis, preferably within 72 h. Follow-up data, available in the clinical records, were reported.

Results

All patients exhibited satisfactory elevation of the depressed bone without associated injuries, except one patient who presented with an associated cephalohematoma which prevented optimal device coupling to generate sufficient vacuum pressure for correction. Neither neurological deficits nor development of epilepsy was noted; normal neurological assessment and oral alimentation tolerance were confirmed within 24 h post procedure.

Conclusions

According to our data, ping-pong skull fracture elevation using the vacuum method is a safe and satisfactory treatment in the neonatal period. Early treatment allows for quick resolution, and in our opinion is the strategy of choice for depressed skull fractures in newborns.

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Acknowledgements

We would like to thank Angelo Shuman for the illustration.

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Authors and Affiliations

  1. Department of Neurosurgery, Universidade Federal de São Paulo, Rua Napoleão de Barros 715, 6th Floor, 04024-002, São Paulo, SP, Brazil

    Sergio Cavalheiro, Mauricio D. Puch Ramírez, María Carolina Portela Fernández, Patricia Alessandra Dastoli & Marcos Devanir Silva da Costa

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  1. Sergio Cavalheiro
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  2. Mauricio D. Puch Ramírez
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  3. María Carolina Portela Fernández
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  4. Patricia Alessandra Dastoli
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  5. Marcos Devanir Silva da Costa
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Contributions

Mauricio Puch: conceptualization, writing of the draft, data acquisition. María Carolina Portela Fernández: data acquisition, writing of the draft, review, and editing. Marcos Devanir Silva da Costa: conceptualization , data acquisition, review and editing. Patricia Alessandra Dastoli: review and editing. Sergio Cavalheiro: supervision, review, and editing.

Corresponding author

Correspondence to Marcos Devanir Silva da Costa.

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The study was approved by the Research Ethics Committee of the Universidade Federal de São Paulo, São Paulo, Brazil. Informed consent was obtained from all the guardians.

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Informed consent was obtained from the guardians for publication.

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The authors declare no conflict of interest.

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Cavalheiro, S., Puch Ramírez, M.D., Fernández, M.C.P. et al. Treatment of depressed skull fractures with vacuum devices in the neonatal period: A case series. Childs Nerv Syst 40, 1213–1219 (2024). https://doi.org/10.1007/s00381-023-06261-z

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