The Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, The Neurological Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Neurosurgery. 2012 Mar;70(1 Suppl Operative):8-14; discussion 14-5. doi: 10.1227/NEU.0b013e31822fef2c.
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.
We evaluate our experience with immediate titanium mesh cranioplasty at the time of craniectomy and debridement.
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.
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.
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.
对于涉及颅骨的开颅术后手术部位感染（SSI），典型的治疗方法包括颅骨切除术、清创术和延迟颅骨成形术。延迟颅骨成形术的缺点包括美容畸形、未保护大脑的脆弱性以及与额外手术相关的风险和成本。许多作者试图通过各种技术来挽救骨瓣。
我们评估了在颅骨切除术和清创术时立即使用钛网颅骨成形术的经验。
我们回顾性分析了因脑肿瘤而行开颅术的患者的 SSI。这些患者接受颅骨切除术、清创术和立即钛网颅骨成形术，然后使用抗生素治疗。主要结果是再次感染。
符合纳入标准的患者有 12 名。感染的危险因素包括术前放疗（33%）、先前的开颅术（33%）和术后脑脊液漏（25%）。中位随访时间为 14 个月。10 名（83%）患者长期无复发感染。1 名患者因持续感染需要再次手术清创，成功植入新的钛网。另一名患者因肿瘤进展而出现反复感染，但选择接受临终关怀。
本系列研究表明，对于存在愈合不良风险因素的患者，在颅骨切除术和清创术时立即进行钛网颅骨成形术是安全可行的。这在有风险因素的患者中得到了证实。即刻颅骨成形术避免了延迟颅骨成形术的缺点、风险和成本。
