Cranioplasty infection [Neurosurgery Wiki]

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====== Cranioplasty infection ======

[[Cranioplasty]] still has one of the highest rates of [[infection]]. 

Cranioplasty infection can lead to [[reoperation]], long-term [[antibiotic]] use, and significant [[morbidity]]
((Cheng Y. K., Weng H. H., Yang J. T., Lee M., Wang T., Chang C. Factors affecting graft infection after cranioplasty. Journal of Clinical Neuroscience. 2008;15(10):1115–1119. doi: 10.1016/j.jocn.2007.09.022.))
((Im S., Jang D., Han Y., Kim J., Chung D. S., Park Y. S. Long-term incidence and predicting factors of cranioplasty infection after decompressive craniectomy. Journal of Korean Neurosurgical Society. 2012;52(4):396–403. doi: 10.3340/jkns.2012.52.4.396.))
((Gooch M. R., Gin G. E., Kenning T. J., German J. W. Complications of cranioplasty following decompressive craniectomy: analysis of 62 cases. Neurosurgical Focus. 2009;26(6):E9. doi: 10.3171/2009.3.FOCUS0962.))
((Beauchamp K. M., Kashuk J., Moore E. E., Bolles G., Rabb C., Seinfeld J., Szentirmai O., Sauaia A. Cranioplasty after postinjury decompressive craniectomy: is timing of the essence? Journal of Trauma: Injury, Infection and Critical Care. 2010;69(2):270–272. doi: 10.1097/TA.0b013e3181e491c2.))
((Durham S. R., McComb J. G., Levy M. L. Correction of large (<25 cm2) cranial defects with “reinforced” hydroxyapatite cement: technique and complications. Neurosurgery. 2003;52(4):842–845.))
((Chun H. J., Yi H. K. Efficacy and safety of early cranioplasty, at least within 1 month. Journal of Craniofacial Surgery. 2011;22(1):203–207. doi: 10.1097/SCS.0b013e3181f753bd.))
((Matsuno A., Tanaka H., Iwamuro H., Takanashi S., Miyawaki S., Nakashima M., Nakaguchi H., Nagashima T. Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochirurgica. 2006;148(5):535–540. doi: 10.1007/s00701-006-0740-6.)).

Patients with a [[ventriculoperitoneal shunt]] tend to develop epidural fluid accumulation after [[cranioplasty]] and also have a higher frequency of [[syndrome of the trephined]] after [[bone flap]] removal. Thus treatment of patients with post[[cranioplasty infection]] and a VP shunt is often challenging.

===== Risk factors =====

[[Cranioplasty infection risk factors]].

===== Clinical features =====

Fever, local signs of inflammation (swelling and/or redness at the operated site), wound drainage and/or dehiscence,
wound pain/headaches, seizures, and focal neurological deficits

===== Prevention =====
see [[Cranioplasty infection prevention]].

===== Treatment =====
[[Cranioplasty infection treatment]].
====Hostile sites====
Hostile sites for cranioplasty occur in patients with a history of radiation, infection, failed cranioplasty, CSF leak or acute infection. 

The incidence of SSI in cranioplasty was associated with modifiable risk factors, i.e., blood glucose levels and skull defect size. Storing bone flaps in subcutaneously preserved abdominal pockets was cost-efficient and carried no additional risk of [[infection]]
((Alkhaibary A, Alharbi A, Abbas M, Algarni A, Abdullah JM, Almadani WH, Khairy 
I, Alkhani A, Aloraidi A, Khairy S. Predictors of Surgical Site Infection in
Cranioplasty: A Retrospective Analysis of Subcutaneously Preserved Bone Flaps in 
Abdominal Pockets. World Neurosurg. 2019 Sep 27. pii: S1878-8750(19)32562-8. doi:
10.1016/j.wneu.2019.09.120. [Epub ahead of print] PubMed PMID: 31568916.
)).

===== Case series =====

[[Cranioplasty infection case series]].

===== References =====