• Roberto Altieri, Erica Grasso, Giacomo Cammarata, Marco Garozzo, Gianmarco Marchese, Francesco Certo, Martino Ruggieri, Raffaele Falsaperla, and Giuseppe Barbagallo.
• Department of Neurological Surgery, Policlinico "G. Rodolico-S. Marco" University Hospital, Catania, Italy; Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy; PhD Program at Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy. Electronic address: roberto.altieri.87@gmail.com.
• World Neurosurg. 2022 Sep 1; 165: 698069-80.

AbstractPing-pong fractures have become less frequent, and no definite predictors to determine which fractures will elevate spontaneously and which should undergo surgical treatment have been clearly defined. Herein, the authors present a revision of the literature, in which 54 papers were included, with a total of 228 children studied. Patients who underwent surgery accounted for 30%; elevation through obstetrical vacuum or other aspiration systems was applied in 30%; and spontaneous resolution occurred in 40%; in 4 patients, percutaneous microscrew elevation was applied. Overall, in 96.4% of patients, the outcome was favorable because we found no significant increase in the incidence of post-traumatic seizures or neurologic sequelae with no significant differences between treated patients and spontaneous elevation. Statistical analysis showed no significant differences among the different treatment methods (P = 0.53). Our results suggest that simple compound ping-pong fractures without brain compression, hematomas, or dural tears could benefit from conservative management. In cases of nonspontaneous resolution after 6 months, operative strategies should be performed, considering that there is no evidence of differences between vacuum elevation and surgical elevation.Copyright © 2022. Published by Elsevier Inc.

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