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Depressed Skull Fx

Last modified by Hussein Abdallah on 2025/04/30 03:37

 

FACTS

TBA 

CONSULT

HPI 

  •  

FOCUSED EXAM

 

IMG 

- evalute for proximity to venous sinus and comment on this when you are staffing. If proximal to dural venous sinus, what region? (makes a difference if first 1/3 or last 1/3. 

- evaluate for pneumocephalus on lung window 

A/P

- note 1
[ ] PRS to close scalp
[ ] Broad spectrum ABx / whatever PRS wants for ABx (Unasyn usually good) 

If open: obligated to operate for early debridement and elevation 

If ALL of the following criteria are met, reasonable to NOT operate
- no pneumocephalus
- no hematoma
- no sharp edged fragment
- no dural penetration
- no gross wound contamination
- no depression over motor area
 

Pros/Cons of Operating

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Post-traumatic leptomeningeal cyst (growing skull fx)

  • very rare complication of skull fx wherein brain progressively herniates through torn dura or as a persistent swelling mass --> neuro deficits / seizures
  • occur days to months after injury
  • Mandatory treatment: surgical exploration with dural closure