Treatment of cranial vault fractures: recent trends toward a more conservative approach

A number of aspects in historical teaching regarding the indications for operative treatment of fractures of the cranial vault have been recently challenged. Several contemporary studies have reported excellent results by employing a more conservative approach regarding the treatment of displaced fractures of the skull. Improvements in the diagnosis of injuries by computerized tomography (CT) scanning, antibiotic therapy, and the ability to rapidly transfer patients to neurosurgical care have allowed neurosurgeons to treat many of these injuries outside the operating room with local irrigation, debridement, and simple closure of the wound. Cosmetic deformities of the skull are one of the few absolute indications for surgical therapy. This article reviews the recent literature regarding skull fractures of the cranial vault and discusses the indications for surgical therapy in these patients and cases where a more conservative approach may be utilized.