A depressed skull fracture often causes direct injury to the underlying brain tissue, leading to cortical irritation and gliosis. This disruption can create an epileptogenic focus, significantly increasing the risk of post-traumatic seizures. Surgical intervention aims to elevate the depressed bone fragments and remove bone fragments or hematomas to minimize this risk. Prompt and careful management during surgery can reduce the incidence of seizures but does not eliminate it entirely. Therefore, seizures remain the most common complication associated with depressed skull fractures.

Reference: Merritt's Neurology, 14th Edition.