title: Immediate titanium cranioplasty after debridement and craniectomy for postcraniotomy surgical site infection.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Varun R
authors.initials: VR
authors.lastname: Kshettry
authors.forename: Sara
authors.initials: S
authors.lastname: Hardy
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Weil
authors.forename: Lilyana
authors.initials: L
authors.lastname: Angelov
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
mesh_terms: D000328:Adult; D000368:Aged; D003399:Craniotomy / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants / Q000592:standards*; D019919:Prosthesis Implantation / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000601:surgery*; D013997:Time Factors; D014025:Titanium / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D014025:Titanium