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

Treatment of depressed cranial vault fractures enlarge

In order to elevate depressed cranial vault fractures make one or more burr holes outside the fractured area.
Save the fragments and bone dust produced by drilling in saline for later reconstruction of the burr hole.


Treatment of depressed cranial vault fractures enlarge

Use a dissector to carefully dissect the dura free.


Treatment of depressed cranial vault fractures enlarge

In some cases, after making a burr hole and inserting an elevator, the bony fragments can be lifted up and the fracture reduced. If successful, no additional craniotomy is necessary.


Treatment of depressed cranial vault fractures enlarge

A craniotomy is performed by linking the burr holes. Bone fragments are then removed.


Treatment of depressed cranial vault fractures enlarge

The fractured segments are removed taking great care to avoid extending dural tears. If fragments have penetrated the brain, special care has to be taken during removal.


Treatment of depressed cranial vault fractures enlarge

If the fragments are interlocked, a routine craniotomy is performed including the depressed fracture. The bone flap is then turned up-side down and the fragments are reduced by using a mallet. The bone flap is replaced and fixed.


Treatment of depressed cranial vault fractures enlarge

If there is a dural laceration, it is highly recommended to open the dura, especially in case of subdural bleeding. After the evacuation of the subdural hematoma, a duraplasty is performed.


Treatment of depressed cranial vault fractures enlarge

Suspension sutures of the dura to the bony margins will minimize the risk of postoperative epidural hematoma.


Treatment of depressed cranial vault fractures enlarge

Reposition the bone flap and secure it to the surrounding bone with rigid fixation. A minimum of three fixation points assures stability.
In some cases, the bone fragments can be used to reconstruct the bone flap using plates and screw. Bone dust or other materials can be used to fill the gaps between the fracture lines.


For further cranioplasty techniques click here.

v1.0 2011-05-14