Operative intracranial infection following craniotomy

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Postoperative infection after cranial surgery is a serious complication that requires immediate recognition and treatment. In certain cases such as postoperative meningitis, the patient can be treated with antibiotics only. In cases that involve a bone flap infection, subdural empyema, or cerebral abscess, however, reoperation is often needed. There has been significant disagreement regarding the incidence of postoperative central nervous system (CNS) infections following cranial surgery. In this paper the authors' goal was to perform a retrospective review of the incidence of CNS infection after cranial surgery at their institution. They focused their review on those patients who required repeated surgery to treat the infection.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors reviewed the medical records and imaging studies in all patients who underwent a craniotomy or stereotactic drainage for CNS infection over the past 10 years. Subgroup analysis was then performed in patients whose infection was a result of a previous cranial operation to determine the incidence, factors associated with infection, and the type of infectious organism. Patients treated nonoperatively (that is, those who received intravenous antibiotics for postoperative meningitis or cellulitis) were not included. Patients treated for wound infection without intracranial pus were also not included.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>During the study period from January 1997 through December 2007, ~ 16,540 cranial surgeries were performed by 25 neurosurgeons. These included elective as well as emergency and trauma cases. Of these cases 82 (0.5%) were performed to treat postoperative infection in 50 patients. All 50 patients underwent their original surgery at the authors' institution. The median age was 51 years (range 2–74 years). There were 26 male and 24 female patients.</jats:p> <jats:p>The most common offending organism was methicillin-sensitive <jats:italic>Staphylococcus aureus</jats:italic>, which was found in 10 of 50 patients. Gram-negative rods were found in 15 patients. Multiple organisms were identified in specimens obtained in 5 patients. Six patients had negative cultures. Most craniotomies leading to subsequent infection were performed for tumors or other mass lesions (23 of 50 patients), followed by craniotomies for hemorrhage and vascular lesions. Almost half of the patients underwent &gt; 1 cranial operation before presenting with infection.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Postoperative infection after cranial surgery is an important phenomenon that needs immediate recognition. Even with strict adherence to sterile techniques and administration of antibiotic prophylaxis, a small percentage of these patients will develop an infection severe enough to require reoperation.</jats:p></jats:sec>

Operative wound-related complications after cranial revascularization surgeries

“…Some studies, which discuss complications after craniotomy surgery without harvesting scalp vessels, suggest that wound infection occurs in about 5% of all patients (1%-11%). 6,7,10,20,25 In the report by Katsuta et al, 10 17.6% of patients who underwent cerebral revascularization surgery developed cutaneous necrosis without the appearance of infection. Based on these reports, wound complications after craniotomy surgery without harvesting scalp vessels are estimated to occur in 10%-15% of all patients.…”

Post Traumatic Meningitis in Neurosurgery Department

“…Other studies have reported S.aureous as the most frequent organism, a lot of results related to nosocomial and post-surgical meningitis [2,10,18,19] . Some other studies have demonstrated Streptococcus pneumonia is the most common pathogen in post-surgical meningitis [6] , however the incidence of S. pneumonia observed more in the children [12] .…”

Impact of resident involvement in neurosurgery: an analysis of 8748 patients from the 2011 American College of Surgeons National Surgical Quality Improvement Program database

“…4,16,32,33,36,37,42,43,45 Neurosurgery studies indicate that increased operative time is a significant risk factor for infections and cranial nerve injury following craniotomy and carotid endarterectomy, respectively. 11,13,22,25 Thus, the differences in operative time between the two cohorts may explain some of the increase in complication rates with resident involvement prior to baseline adjustment.…”