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Depressed skull fracture compressing eloquent cortex causing focal neurologic deficits
Alexander In1,2, Brittany M Stopa1,2, Joshua A Cuoco1,3,4
1Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA.
Brain Injury
|January 27, 2023
Summary
Emergent cranioplasty for depressed skull fractures can rapidly restore neurologic function. Immediate elevation of depressed fragments relieved cortical compression, leading to excellent outcomes in a rare case.
Area of Science:
- Neurosurgery
- Trauma Surgery
Background:
- Depressed skull fractures result from high-impact head injuries.
- Conservative management is typical unless specific criteria like dural violation or significant depression are met.
- Cranioplasty is usually urgent, not emergent, unless neurologic deficits arise.
Observation:
- A 40-year-old male with a mechanical fall presented with severe neurological deficits including hemiplegia and facial palsy.
- These deficits were attributed to a depressed skull fracture fragment compressing the eloquent cortex.
- The patient underwent emergent cranioplasty for fragment elevation within two hours of injury.
Findings:
- Emergent cranioplasty for depressed skull fractures causing focal neurologic deficits is a rare but effective intervention.
- Immediate surgical intervention led to complete recovery of neurologic function without residual deficits at six months.
Implications:
- This case highlights a rare indication for emergent cranioplasty.
- Prompt surgical decompression of the cortex in depressed skull fractures can yield excellent functional outcomes.
- Highlights the importance of timely surgical intervention in specific traumatic brain injury cases.
