Occipital skull fracture

Skull fracture of the occipital bone.

One hundred thirty-four cases of occipital skull fracture seen over the past 15 years at the Medical Center Hospital of Vermont have been analyzed with respect to their clinical course and neurologic outcome. Among the cases reviewed, one third of patients had an uncomplicated course, 24% recovered with mild neurologic findings (such as cranial nerve palsy), and 13% died as a result of neurologic insult. This high morbidity results from combinations of traumatic subarachnoid hemorrhage, Coup contrecoup injury, and injury at the skull base. Posterior fossa hematoma, cerebellar contusion, parietal and occipital lobe injury, and cranial nerve injury associated with this lesion are discussed in detail. CAT scanning is now part of there diagnostic routine in patients with occipital fracture in coma grades 1-5 (Grady coma scale) ¹⁾.

Depressed skull fractures overlying the major venous sinus are often managed nonoperatively because of the high associated risks of surgery in these locations. In the presence of clinical and radiographic evidence of sinus occlusion, however, surgical therapy may be necessary.

Vender and Bierbrauer presented the case of a 9-year-old boy with a depressed skull fracture overlying the posterior third of the superior sagittal sinus. After initial conservative treatment, delayed signs of intracranial hypertension and a symptomatic tonsillar herniation with tonsillar necrosis developed. Possible causes as well as diagnostic and treatment options are reviewed ²⁾.

Depressed occipital skull fracture with associated sagittal sinus occlusion ³⁾.