Q. I was left with a hole in the skull after hematoma evacuation. Is it safe?

Answered by
Dr. Sudheer Ambekar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Sep 08, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

Seven months ago, I had a serious head injury. That time, I was left with a small hole in the skull after extradural hematoma evacuation. Then, I had no discomfort in the head. Now, I have terrible tension around the back of the head and dull pressure and pain next to the hole. I feel hyperemotional, frightened, extreme anxiety and jaw clenching. I had none of these for seven months post surgery. Is it safe to live with this hole? What is underneath it? Will it affect my life? Why am I getting sudden extreme head tension and dull aches? From yesterday, I am taking beta blockers for stress and tension. My neurologist said that I am free from brain damage. But, I need more advice.



Welcome to icliniq.com.

A small piece of the skull bone could be cut and the hole in the bone was made. According to the reports (attachment removed to protect patient identity), there is no residual brain damage. Under these circumstances, I can explain your headache as follows.

The pain around the burr hole may be due to fibrosis and scar formation, which makes the scalp tough. Skin traction around the burr hole may be due to this scar formation. Treatment is usually symptomatic with pain medications.

The headache may also be related to post-traumatic stress disorder. You should see a psychiatrist for diagnosis and therapy. Treatment may include antidepressants and behavioral therapy.

Given that there is no evidence of residual head injury, your headache may be unrelated to the prior injury. It may simply be tension headache, which is very common. Treatment is with pain medications and avoiding the stressors.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Thank you doctor,

Is it safe to live with this open hole? Is it common to leave the hole open instead of putting a plate? Will it result in delayed onset of brain damage or headaches? Is it fine to massage the skin over the hole?



Welcome back to icliniq.com.

Yes, it is safe to live a normal life with the hole in the skull. Many patients, who undergo surgery for traumatic brain injury or for other conditions such as tumor, have these holes.

  • Plates and screws are used to fix the bone flap in place and not to close the hole.
  • If you have recovered from the initial injury, extradural hematoma has a very good outcome and there is almost zero chance that you will have delayed sequel.
  • It is fine to massage the skin around the hole, but should not cause any harm.

For further information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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