Loeser et al listed a number criteria for when to operate on a neonate with a depressed skull fracture.
Patient selection: neonate with a depressed skull fracture following a difficult delivery
Indications for surgery to correct the fracture:
(1) bone fragment within cerebral tissue
(2) presence of neurological deficits
(3) evidence of increased intracranial pressure
(4) presence of cerebrospinal fluid (CSF) beneath the Galea
(5) inability to elevate the bone by nonsurgical means (suction pump, etc)
Choux recommends surgical elevation in most cases, unless the fracture is small and located over a venous sinus. The incidence of seizures is lower in neonates who have been operated on, and sometimes the extent of injury can only be appreciated at surgery.
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