A fracture occurs when there is a break in part of the skull bones. The skull bone serves to protect our brain from external injury. A fracture of the skull occurs when there is a heavy blow to the head. This can occur after a fall, road traffic accident or being hit on the head by a hard object.

There are several types of skull fractures with varying severity as follows:

Due to the impact that is sustained to cause a skull fracture, such injuries may also be associated with injuries to the underlying brain. In simple skull fractures such as a liner fracture or mildly depressed skull fracture, there is no need for any major operation to repair the fracture and healing will take place on its own over the next few weeks. If there is a more complex compound fracture, then one will have to be taken to the operating theatre to clean the scalp wound and for surgery to lift up the depressed bony fragments and repair the torn membrane lining the brain. In some circumstances when there is extensive injury to the bone and brain, portions of the cracked skull will be removed and later reconstructed with synthetic materials or a metal mesh. This procedure to replace the bone is called a cranioplasty.

Base of skull fractures are usually managed conservatively if there is no leak of cerebrospinal fluid (CSF). The fractured bones will heal and unite with time. In the event that there is cerebrospinal fluid leakage, a very fine plastic tubing called a lumbar drain will have to be inserted via the lower back in the ward to allow an alternative route for the CSF to flow. This will give time to allow the torn area of membrane to heal up. In the unlikely event that this does not occur then surgery will need to be performed to repair the area of torn membrane.

A craniotomy is a neurosurgical procedure to gain access into various locations of the brain. Depending on the location of blood clot, a curved skin incision is made at a particular location of the head to lift up a portion of the scalp and expose an underlying region of bone. Drills and special bone saws are then used to cut around part of the skull and remove a disc of bone. The membrane overlying the brain is then exposed and this layer is then further cut opened to expose the underlying brain surface.

This procedure is generally similar for operations to remove extradural, subdural or intracerebral hematomas. The membrane covering the surface of the brain is opened for surgery to remove subdural and intracerebral hematomas but it is not performed if a patient only has an extradural hematoma.

At the end of the operation after the blood clots are evacuated from the various locations, everything is replaced as it was before the operation. The membrane covering the brain surface is stitched back and the bone is replaced and secured with screws or wires. If there is extensive swelling of the brain in certain circumstances, the bone may not be replaced and the scalp is just closed over the bone defect and the skin stitched close. A cranioplasty may then be performed at a later date to replace the bone.

This is a surgical procedure to reconstruct a portion of bone of the skull that was previously removed. The reasons for performing this procedure are for cosmetic purposes and for protection of the underlying brain. In certain circumstances, it can help to improve neurological function as well as to relieve headaches in patients where there is a large defect after previous removal of the bone.

The materials used to repair the defect can be the previously removed bone if it remains intact, or other materials such as a titanium mesh or plate and synthetic acrylic materials that can be shaped to match the contour of the skull bone.

The procedure is performed under general anaesthesia which lasts about 2 hours. During the procedure, the scalp over lying the bony defect is lifted up through the previous scar and the bone or synthetic material is shaped to fit the defect and secured with metal plates and screws or wires. The expected duration of hospital stay is about 5 days.