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Immediate Titanium Cranioplasty After Debridement and Craniectomy for Postcraniotomy Surgical Site Infection

Kshettry, Varun R. MD; Hardy, Sara BA; Weil, Robert J. MD; Angelov, Lilyana MD; Barnett, Gene H. MD

doi: DOI: 10.1227/NEU.0b013e31822fef2c
Instrumentation and Technique

BACKGROUND: For postcraniotomy 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 by 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. The primary outcome was recurrent infection.

RESULTS: Twelve patients met the inclusion criteria. Risk factors for infection included preoperative radiation therapy (33%), prior craniotomy (33%), and postoperative 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 because of 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 postcraniotomy 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.

The Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, Ohio

Correspondence: Gene H. Barnett, MD, Brain Tumor and Neuro-Oncology Center, The Neurological Institute, Mail Desk: S-73, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. E-mail:

* These authors have contributed equally to this project.

Received November 30, 2010

Accepted May 17, 2011

Copyright © by the Congress of Neurological Surgeons