Executive Editor: Daniel Buchbinder General Editor: Daniel Buchbinder

Authors: S Fusetti, B Hammer, R Kellman, C Matula, EB Strong, Co-author: A Di Ieva

Skull base & Cranial vault - Cranial vault

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Glossary

General considerations

Depressed fractures in general require surgical management. Functional and or esthetic considerations must be kept in mind. From the functional point of view, decompression of the brain requires acute treatment.

Observation
Main indication Skill Equipment
Non- or minimally displaced fractures not involving the frontal sinus, without CNS or vascular injury, and stable neurological status. Basic surgical experience, no specialized skills Basic equipment only

Further indications

  • No evidence of an intracranial mass lesion (bleeding), CSF leak (CSF rhinorrhea), or increase in intracranial pressure
  • Stable neurological status (high Glasgow coma scale GSC)

CAUTION: A linear cranial vault fracture, even if not displaced on computed tomography, may tear the dura (occurring typically in children, e.g., growing fractures).

Treatment of depressed cranial vault fractures
Main indication Skill Equipment
Depressed fractures (decompression of the brain requires acute treatment). Some specialized surgical experience Simple surgical and imaging resources

Further indication

  • Non-displaced fractures located over the frontal sinus that can cause late complications such obstruction or frontal sinus mucocele due to mucous-membrane laceration

Linear cranial vault fracture, even if not displaced on computed tomography, may tear the dura (occurring typically in children, e.g., growing fractures).

Bone fragments can also cause skin lacerations and/or subgaleal hematoma.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2011-05-14