Immediate Titanium Cranioplasty after Debridement and Craniectomy for Post-Craniotom

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BACKGROUND: For post-craniotomy surgical site infection (SSI) involving the bone, typical management involves craniectomy, debridement and delayed cranioplasty. Disadvantages to delayed cranioplasty include cosmetic deformity, vulnerability of unprotected brain, and risks and costs associated with an additional operation. Many authors have attempted bone flap salvage using various techniques.

OBJECTIVE: We evaluate our experience with immediate titanium mesh cranioplasty at the time of craniectomy and debridement.

METHODS: We retrospectively reviewed SSIs in patients that underwent craniotomy for treatment of a brain tumor. These patients were treated with craniectomy, debridement, and immediate titanium mesh cranioplasty followed by antibiotics. Primary outcome was recurrent infection.

RESULTS: Twelve patients met the inclusion criteria. Risk factors for infection included pre-operative radiation therapy (33%), prior craniotomy (33%), and post-operative CSF leak (25%). Median follow-up was 14 months. Ten (83%) patients had long-term resolution without recurrent infection. One patient required additional surgical debridement for persistent infection with successful placement of new titanium mesh. Another patient developed recurrent infection but opted for hospice care due to tumor progression.

CONCLUSION: This series demonstrates the safety and feasibility of performing immediate titanium cranioplasty at the time of craniectomy and debridement in patients with post-craniotomy infections. This has been shown in patients with risk factors for poor wound healing. Immediate cranioplasty avoids the drawbacks, risks, and costs of delayed cranioplasty.

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.