In the absence of all localizing features the decompression should be carried out on the right side of the head, in order to avoid all possibility of including, in the hernial protrusion that may result, the motor speech area of Broca.
In cases of severe head-injury the surgeon must be prepared for many disappointments, but, from my own experience, it would appear that Cushing’s operation frequently brings about the most satisfactory results.
It should, however, be clearly understood that indiscriminate decompression operations only bring discredit on the method in general. They should only be carried out in suitable cases.
TREATMENT OF FRACTURES OF THE VAULT OF THE SKULL
Indications for operation.
It is the general custom to divide fractures of the vault into two groups—those demanding operative treatment and those in which an expectant attitude is advised—and between these two groups a sharp line of demarcation is drawn. There is, however, no such line of demarcation. In the event of the general condition of the patient being compatible with operative interference, such treatment is urgently called for under the following conditions:—
All cases of punctured fracture.
All cases of depressed fracture, whether diagnosed by palpation or by inference, whether simple or compound, whether complicated or not.
All cases of fracture complicated by extra-dural or localized subdural extravasation of blood.
All elevated fractures.