Neurosurgery

Skull Fracture

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About Skull Fracture

Depressed skull fractures

General Information

  • Depressed skull fractures involve a portion of the skull extending into the brain cavity.

Symptoms

  • This type of fracture often causes pressure on the brain or direct injury to the brain. In addition, the bone fragment may cut the dura mater, a relatively tough covering over the brain, causing a cerebrospinal fluid leak.

Diagnosis

  • Computed tomography (CT) scans of the brain identify skull fractures in about two thirds of head injury patients.

Treatment

  • Criteria for surgical repair of a depressed skull fracture include the following:
    • A depression greater than 8-10mm (or greater than the thickness of the skull).
    • Brain function difficulties related to pressure or injury of the underlying brain.
    • Cerebrospinal fluid leakage.
    • An open depressed skull fracture, or a fracture exposed by a cut in the scalp.

Outcome

  • The type underlying brain injury determines the level of recovery from a depressed skull fracture.
  • If no brain injury occurs then the surgery represents a cosmetic procedure and the outcome is generally quite good.

Basal Skull Fractures

General Information

  • Basal skull fractures involve the floor of the skull. These include skull fractures around either ear, the eyes, near the spine, and the nasal cavity.

Symptoms

  • The clinical signs of a basal skull fracture may include the following:
    • Cerebrospinal fluid leakage.
    • Blood behind the eardrum.
    • Bruising behind the ears or around the eyes.
    • Nerve damage, causing weakness of the face.
    • Loss of hearing, smell or vision; or double vision.

Diagnosis

  • Computed tomography (CT) scans of the brain identify skull fractures in about two thirds of head injury patients.

Treatment

  • Most basal skull fractures do not require treatment. These fractures tend to heal themselves.
  • Persistent cerebrospinal fluid leakage may warrant surgery to stop the leakage, particularly leaks related to skull fractures near the eyes and nasal cavity.

The Neuro-ICU cares for patients with all types of neurosurgical and neurological injuries, including stroke, brain hemorrhage, trauma and tumors. We work in close cooperation with your surgeon or medical doctor with whom you have had initial contact. Together with the surgeon or medical doctor, the Neuro-ICU attending physician and team members direct your family member's care while in the ICU. The Neuro-ICU team consists of the bedside nurses, nurse practitioners, physicians in specialty training (Fellows) and attending physicians. UCLA Neuro ICU Family Guide