Background and Objectives: Depressed skull fracture (DSF) is a traumatic injury characterized by a segment of the skull vault being displaced below its anatomical position, frequently accompanied by intracranial injuries such as vascular damage, brain injury, and long-term complications. The optimal timing for surgical intervention in DSFs, particularly in low- and middle-income countries (LMICs), remains undefined. Objectives: This study aimed to evaluate the impact of surgical timing on short-, medium-, and long-term outcomes, including functional recovery, systemic inflammation, surgical site infections (SSIs), and post-traumatic epilepsy (PTE). Methods: This thesis presents findings from several prospective cohort studies, investigating functional neurological recovery, inflammatory cytokine profiles, SSI incidence, and the occurrence of PTE. It explores the role of surgical timing and key perioperative clinical and radiological factors in determining outcomes for DSF patients. Results and Significance: