• Coleman P Riordan, Brittany Owusu-Adjei, Rrita Daci, Alannah Phelan, Constance J Mietus, Jacob Kosarchuk, William Lambert, Hanya M Qureshi, Jeewoo Chelsea Lim, Olivia Mihalek, Danielle Li, Omar Sorour, Christopher Homsy, James Kryzanski, Ricardo Aulet, and Mark D Johnson.
• Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
• Neurosurgery. 2024 Jun 10.

Background And ImportanceTrephination is a procedure in which a small hole is made in the skull. Rare cases of self-trephination by individuals seeking medical benefit have been reported. Excoriation disorder is a compulsive skin-picking condition in which an individual self-inflicts cutaneous lesions. Left untreated, severe excoriation disorder can pose significant health risks.Clinical PresentationHere, we describe 5 patients who presented with self-trephination due to a severe form of compulsive cranial excoriation at 2 neighboring academic medical centers over a 4-year period. We review the clinical presentation of self-trephination in cranial excoriation disorder and associated risk factors, surgical and nonsurgical interventions, complications of the disease, treatments, and mortality. Defining clinical characteristics include repetitive self-induced destruction of the scalp and skull with entry into the intracranial compartment, frequent psychiatric comorbidities, infection or injury of the brain with consequent neurological morbidity or mortality, and frequent treatment failures because of poor adherence.ConclusionSelf-trephination in cranial excoriation disorder is a severe neuropsychological disorder and neurosurgical emergency that exposes the brain and is often life-threatening. Appropriate therapy requires antibiotics, surgical debridement and repair of the wound, and concomitant effective psychiatric management of the underlying compulsion, including the use of antidepressants and behavioral therapy.Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.

7 keywords...

hide…