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Role of Preoperative 3-Dimensional Computed Tomography Reconstruction in Depressed Skull Fractures Treated With Craniectomy: A Case Report of Forensic Interest

Viel, Guido MD*; Cecchetto, Giovanni MD*; Manara, Renzo MD; Cecchetto, Attilio MD, PhD; Montisci, Massimo MD, PhD*

The American Journal of Forensic Medicine and Pathology: June 2011 - Volume 32 - Issue 2 - p 172-175
doi: 10.1097/PAF.0b013e318219c88c
Case Reports

Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the injuries before surgical intervention, can help the forensic examiner in identifying skull fracture origin and the means of production.

We report the case of a 41-year-old-man presenting at the emergency department with a depressed skull fracture at the vertex and bilateral subdural hemorrhage. The patient underwent 2 neurosurgical interventions (craniotomy and craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone injuries before craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic injuries. Moreover, based on the shape and size of the depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm.

From the *Department of Environmental Medicine and Public Health, Institute of Legal Medicine, University of Padova; †Neuroradiologic Unit, University Hospital of Padova; and ‡Department of Diagnostic Science and Special Therapies, Pathology Unit, University of Padua, Padova, Italy.

Manuscript received May 20, 2008; accepted November 13, 2008.

Reprints: Guido Viel, MD, Department of Environmental Medicine and Public Health, Institute of Legal Medicine, University of Padova, Via Falloppio 50, 35121 Padova, Italy. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.