In a depressed skull fracture with loose fragments, which surgical approach is indicated to relieve pressure and remove fragments?

• A. Burr holes
• B. Craniectomy
• C. External decompression
• D. Craniotomy for evacuation of blood and decompression

Answer: (D)

The key idea is that a depressed skull fracture with loose bone fragments causing mass effect requires direct surgical exposure to remove the fragments and evacuate any blood collection, so pressure on the brain is relieved. Creating a bone flap through a craniotomy provides the necessary access to precisely elevate the depressed fragments, clear away debris, and drain hematoma while allowing controlled decompression. Burr holes only make small openings and won’t permit removal of multiple loose fragments or thorough hematoma evacuation. External decompression isn’t a definitive method for addressing intracranial mass effect in this context. Craniectomy can relieve swelling by removing a bone segment, but it doesn’t encompass the controlled removal of the loose fragments and evacuation of blood as effectively as a craniotomy. Therefore, craniotomy for evacuation of blood and decompression best meets the goal of relieving pressure and removing the fragments.