Which surgical plan is appropriate for a depressed parietal fracture with subdural hematoma?

• A. Craniotomy for evacuation of blood and decompression of the cranium.
• B. The patient will receive life support measures until the condition stabilizes.
• C. Immediate burr holes will be made to rapidly decompress.
• D. The patient will be treated conservatively with close monitoring.

Answer: (A)

The main concept here is that a depressed skull fracture with a subdural hematoma causing mass effect requires definitive surgical decompression to relieve ICP and remove the hematoma. A craniotomy allows the surgeon to elevate the depressed bone fragments, remove the subdural clot, and decompress the brain directly. This addresses both the structural injury and the pressure pushing on brain tissue, which is essential to prevent further brain injury and herniation.

Burr holes may be used in some rapid decompression scenarios for certain subdural bleeds, but they don’t provide access to depressions of the skull or allow complete evacuation of the hematoma and repair of the fracture. So they’re not adequate for a depressed skull fracture with a subdural hematoma. Conservative management or relying on life support alone fails to treat the mass effect and would not adequately reduce ICP or protect neural tissue.