title: Hyperbaric oxygen treatment of postoperative neurosurgical infections.
abstract: OBJECTIVE
  To evaluate the clinical usefulness of hyperbaric oxygen (HBO) therapy for neurosurgical infections after craniotomy or laminectomy.
  
  
  METHODS
  The study involved review of medical records, office visits, and telephone contacts for 39 consecutive patients who were referred in 1996 to 2000. Infection control and healing without removal of bone flaps or foreign material, with a minimum of 6 months of follow-up monitoring, were considered to represent success.
  
  
  RESULTS
  Successful results were achieved for 27 of 36 patients, with a mean follow-up period of 27 months (range, 6-58 mo). One patient discontinued HBO therapy because of claustrophobia, and two could not be evaluated because of death resulting from tumor recurrence. In Group 1 (uncomplicated cranial wound infections), 12 of 15 patients achieved healing with retention of bone flaps. In Group 2 (complicated cranial wound infections, with risk factors such as malignancy, radiation injury, repeated surgery, or implants), all except one infection resolved; three of four bone flaps and three of six acrylic cranioplasties could be retained. In Group 3 (spinal wound infections), all infections resolved, five of seven without removal of fixation systems. There were no major side effects of HBO treatment.
  
  
  CONCLUSIONS
  HBO treatment is an alternative to standard surgical removal of infected bone flaps and is particularly useful in complex situations. It can improve outcomes, reduce the need for reoperations, and allow infection control without mandatory removal of foreign material. HBO therapy is a safe, powerful treatment for postoperative cranial and spinal wound infections, it seems cost-effective, and it should be included in the neurosurgical armamentarium.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Karolinska Hospital, Stockholm, Sweden. agneta.larsson@hbo.ks.se
authors.forename: Agneta
authors.initials: A
authors.lastname: Larsson
authors.forename: Mats
authors.initials: M
authors.lastname: Engström
authors.forename: Johan
authors.initials: J
authors.lastname: Uusijärvi
authors.forename: Lars
authors.initials: L
authors.lastname: Kihlström
authors.forename: Folke
authors.initials: F
authors.lastname: Lind
authors.forename: Tiit
authors.initials: T
authors.lastname: Mathiesen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006931:Hyperbaric Oxygenation; D007796:Laminectomy; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000209:etiology / Q000628:therapy; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000628:therapy; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000209:etiology / Q000628:therapy; D013530:Surgical Wound Infection / Q000209:etiology / Q000628:therapy*