A craniotomy wound infection is a type of infection that can occur after undergoing a craniotomy
Although every effort is made to maintain a sterile environment during the surgery, infections can still occur due to various factors.
Bacterial contamination: Bacteria from the patient's own skin or from the surgical instruments can enter the wound during the procedure. Impaired immune system: If the patient has a weakened immune system, such as from certain medical conditions or medications, they may be more susceptible to infections.
Prolonged surgery: Longer surgical procedures increase the risk of infection as they provide more time for bacteria to enter the wound.
Poor wound care: Inadequate cleaning and dressing of the wound after the surgery can increase the risk of infection. Pre-existing infections: If the patient has an infection elsewhere in the body, it can spread to the surgical site.
Signs of a craniotomy wound infection may include:
Increased pain, tenderness, or swelling around the incision site.
Redness or warmth around the wound.
Pus or discharge from the wound.
Foul odor coming from the wound.
Fever and chills.
Headaches or other neurological symptoms.
Monitor symptoms: Pay close attention to the wound site and observe for any signs of infection, such as increased pain, redness, swelling, or discharge. Take note of any changes in the wound's appearance, such as foul odor or delayed healing. Additionally, monitor temperature for signs of fever.
Blood tests or wound cultures, to confirm the presence of an infection and determine the appropriate treatment.
Monitor progress: Keep a close eye on the wound's progress and monitor any changes.
Prompt treatment of a craniotomy wound infection is important to prevent further complications. The treatment may involve:
Antibiotics: Depending on the severity of the infection, intravenous or oral antibiotics may be prescribed to fight the infection.
Wound care: The wound may need to be cleaned and dressed regularly to promote healing and prevent further infection.
Drainage: In some cases, if there is an abscess or collection of pus, a surgical drain may be placed to help remove the fluid.
Debridement: In more severe cases, surgical debridement may be required to remove infected or dead tissue from the wound.
Supportive care: Pain management and measures to support the patient's overall health and immune system may be provided.
Efforts to prevent craniotomy wound infections include:
Strict sterile technique during surgery, including proper cleaning and disinfection of neurosurgical instruments. Antibiotics given before surgery, if necessary, to reduce the risk of infection. Proper wound care and dressing after surgery, with regular monitoring for signs of infection. Controlling other risk factors, such as managing underlying medical conditions and optimizing the patient's overall health.
Epidural abscess may extend into the subdural space to cause subdural empyema. Both epidural abscess and subdural empyema may progress to meningitis, cortical venous thrombosis, or brain abscess. Subdural empyema can rapidly spread to involve an entire cerebral hemisphere.
A systematic review was conducted as per PRISMA guidelines to explore existing primary evidence on the risk factors for SSIs post-craniotomy. A comprehensive search of MEDLINE, EMBASE, and Pubmed was performed from database inception up to June 2023. 43 studies were included in the meta-analysis, encompassing a total of 68,881 patients.
The strongest predictor for SSIs was found to be CSF leak (OR: 8.91, CI: 4.30 - 18.44). Other significant factors included infratentorial surgery (OR: 0.43, CI: 0.31 - 0.61), emergency surgery (OR: 1.41, CI: 1.05 - 1.91), re-intervention (OR: 3.19, CI: 1.77 - 5.75), prolonged operative time (mean difference: 33.25; CI: 18.83 - 47.67), hospital length of stay (mean difference: 0.60; CI: 0.23 - 0.98) and ICPM insertion (OR: 1.81; CI: 1.06 - 3.11). Contrarily, sex, BMI, diabetes, antibiotic prophylaxis, immunosuppressive agents, trauma, and use of artificial implants did not demonstrate statistical significance.
This meta-analysis provides an up-to-date and comprehensive evaluation of risk factors for SSIs post-craniotomy. It emphasizes the need for preventive strategies, particularly against CSF leaks, and calls for further research to elucidate the intricate relationships between these factors 1).
Patients who underwent neuro-oncologic craniotomy between 2006 and 2020 were included. Medical records were reviewed to identify the occurrence of wound infection at ≤ 3 months postoperatively. Potential risk factors for infection included tumor pathology, location, anesthesia type, indication, ventricular entry, foreign body, brachytherapy, lumbar drain, prior operation, prior cranial radiation, prior infection, bevacizumab, and medical comorbidities (hypertension, obesity, diabetes, hyperlipidemia, other cancer, cirrhosis). Logistic regression was implemented to determine risk factors for SSI. Chi-square tests were used to assess whether the number of risk factors (e.g., 0, ≥ 1, ≥2, ≥ 3, ≥4) increases the risk of SSI compared to patients with fewer risk factors. The relative increase with each additional risk factor was also evaluated.
A total of 1209 patients were included. SSI occurred in 42 patients (3.5%) by 90 days after surgery. Significant risk factors on multivariate logistic regression were bevacizumab (OR 40.84; p < 0.001), cirrhosis (OR 14.20, p = 0.03), foreign body placement (OR 4.06; P < 0.0001), prior radiation (OR 2.20; p = 0.03), and prior operation (OR 1.92; p = 0.04). Infection rates in the combinatorial analysis were as follows: ≥1 risk factor = 5.9% (OR 2.74; p = 0.001), ≥ 2 = 6.7% (OR 2.28; p = 0.01), ≥ 3 = 19.0% (OR 6.5; p < 0.0001), ≥ 4 = 100% (OR 30.2; p < 0.0001).
Risk factors in aggregate incrementally increase the risk of postoperative surgical site infection after craniotomy for tumor 2).
Buchanan et al. identified 93,920 nonemergent craniotomies. There were 2079 cases of SSI (2.2%) and 835 reoperations for washout (0.89%) within 30 days of index admission and there were 2761 cases of SSI (3.6%) and 1220 reoperations for washout (1.58%) within 90 days. Several factors were predictive of SSI in multivariate analysis, including tumor operations, external ventricular drain (EVD), age, length of stay, diabetes, discharge to an intermediate-care facility, insurance type, and hospital bed size. Many of these factors were similarly implicated in reoperation for washout.
SSI incidence in neurosurgery is low and most readmissions occur within 30 days. Several factors predicted SSI after craniotomy, including operations for tumor, younger age, hospitalization length, diabetes, discharge to institutional care, larger hospital bed size, Medicaid insurance, and presence of an EVD. Diabetes and EVD placement may represent modifiable factors that could be explored in subsequent prospective studies for their associations with cranial SSIs 3)