However, as the ionizing radiation dose of 3D-CT is several hundred-fold greater than simple X-rays, there have been concerns for potential carcinogenesis after long term exposure as well as for the increased cost and complexities should all simple X-rays be replaced by 3D-CT 1, 6). In addition, there are reports that site-specific skull fractures or depression skull fractures are related to intracranial injury, and therefore the application of 3D-CT in all cases of skull fractures have been suggested 4, 13). Recent advances in the high resolution image reconstruction of 3-dimensional computer tomography (3D-CT) has led to marked improvement of skull fracture diagnosis rates, and hence there is widespread opinion that the diagnostic rates of skull fractures by 3D-CT is far superior to that of simple X-rays, from newborn to infants. While the diagnosis of the fracture itself is not clinically more important than intracranial hemorrhage, contusion, or ischemia, other events that accompany skull fractures such hemorrhaging, CSF leakage, neurovascular injury, meningitis, cranial nerve palsy, carotid artery dissection, and carotid-cavernous fistula may be present, as well as legal compensation issues 13, 15). This is assumed to be due to the fact that in the pediatric population the skull has not yet undergone ossification and it is therefore the diagnostic rates of skull fractures by simple X-rays seem to be lower compared to adults 11). Although the simple skull X-rays are regarded as the most basic imaging tool in patients with skull fractures, there exists debate regarding the exact role in the diagnosis of skull fractures 4, 9, 16). While skull fractures in children are common, there is disagreement among medical institutions with regard to the diagnostic method. Every year 1500000 children are afflicted with skull fractures in the United States, 1200000 children visit the emergency services, 250000 are admitted, and among them 50000 die from this injury 7, 14). ![]() Skull fractures are known to be the most common underlying etiology of death among the various types of pediatric injuries.
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