title: Cerebral Myiasis Associated with Artificial Cranioplasty Flap: A Case Report.
abstract: BACKGROUND
  Cranioplasty is a commonly performed procedure for the repair of cranial defects. Various materials have been used for this procedure and have a good safety profile. Human cerebral myiasis is an exceedingly rare condition. It involves the invasion of live or dead human tissues by larvae of the insect species dipterous.
  
  
  METHODS
  We describe the first case of cerebral myiasis associated with an artificial cranioplasty bone flap. There was delayed cerebral cortex infestation of the species dipterous after cranioplasty with polymethyl methacrylate bone flap. The patient initially presented with an acute subdural hematoma and contaminated, comminuted frontal bone fracture that required craniectomy with interval cranioplasty at 3 months. Two years after the index procedure, the patient presented for neurosurgical follow-up because of 2 months of nonhealing ulcers and a foul smell emanating from the cranioplasty site, as well as acute onset of unilateral arm and leg weakness. Surgical exploration found live larvae invading the dura and cerebral cortex, an area that was thoroughly debrided with good outcomes for the patient.
  
  
  CONCLUSIONS
  Cerebral myiasis can be managed via surgical and antibiotic therapy to obtain a good clinical outcome.
authors.affiliation: Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India.
authors.forename: Sachin Ashok
authors.initials: SA
authors.lastname: Giri
authors.affiliation: Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Kotecha
authors.affiliation: Department of General Medicine, Zynova Heart Hospital, Mumbai, India.
authors.forename: Deepali
authors.initials: D
authors.lastname: Giri
authors.affiliation: Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India. Electronic address: batuk73@yahoo.co.in.
authors.forename: Batuk
authors.initials: B
authors.lastname: Diyora
authors.affiliation: Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India.
authors.forename: Naren
authors.initials: N
authors.lastname: Nayak
authors.affiliation: Department of Neurosurgery, Lokmanya Tilak Municipal General Hospital, Sion, Mumbai, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D000818:Animals; D001843:Bone Cements; D002540:Cerebral Cortex / Q000473:pathology; D003399:Craniotomy / Q000009:adverse effects; D003646:Debridement; D056424:Decompressive Craniectomy; D004175:Diptera; D004388:Dura Mater / Q000473:pathology; D020199:Hematoma, Subdural, Acute / Q000601:surgery*; D006801:Humans; D007814:Larva; D008297:Male; D009198:Myiasis / Q000209:etiology* / Q000628:therapy*; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000628:therapy*; D013524:Surgical Flaps / Q000009:adverse effects* / Q000601:surgery*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: Cranioplasty; Infection; Myiasis