• World Neurosurg · Mar 2023

    Immediate Titanium Mesh Cranioplasty After Debridement and Craniectomy for Post-Craniotomy Surgical Site Infections and Risk Factors for Reoperation.

    • Tamia Potter, Roger Murayi, Peter Ahorukomeye, Jordan C Petitt, Jakub Jarmula, Maria Krywyj, Arbaz Momin, Pablo F Recinos, Alireza M Mohammadi, Lilyana Angelov, Gene H Barnett, and Varun R Kshettry.
    • Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
    • World Neurosurg. 2023 Mar 1; 171: e493e499e493-e499.

    BackgroundWe previously published a novel strategy for management of postcraniotomy bone flap infection consisting of single stage debridement, bone flap removal, and immediate titanium mesh cranioplasty.MethodsPostcraniotomy patients with surgical site infections treated with surgical debridement, bone flap removal, and immediate titanium mesh cranioplasty were retrospectively reviewed. The primary outcome measure was reoperation due to persistent infection or wound healing complications from the titanium mesh.ResultsWe included 48 patients, of which 15 (31.3%) were female. The most common primary diagnoses were glioblastoma (31.3%), meningioma (18.8%), and vascular/trauma (16.7%). Most patients had a history of same-site craniotomy prior to the surgery complicated by surgical site infection and 47.9% had prior cranial radiation. Thirty-six (75.0%) patients achieved resolution of their infection and did not require a second operation. Twelve (25.0%) patients required reoperation: 6 (12.5%) patients were found to have frank intraoperative purulence on reoperation, whereas 6 (12.5%) had reoperation for poor wound healing without any evidence of persistent infection. Cochran Armitage trend test revealed that patients with increasing number of wound healing risk factors had significantly higher risk of reoperation (P = 0.001). Prior intensity modulated radiotherapy alone was a significant risk factor for reoperation (6.5 [1.40-30.31], P = 0.002). Median follow-up time was 20.5 weeks.ConclusionsImmediate titanium mesh cranioplasty at the time of debridement and bone flap removal is an acceptable option in the management of post-craniotomy bone flap infection. Patients with multiple wound healing risk factors are at higher risk for reoperation.Copyright © 2022 Elsevier Inc. All rights reserved.

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