Wallace David J, McGinity Michael J, Floyd John R
Department on Neurosurgery, University of Texas Health Science Center, San Antonio, TX, USA.
Neurosurg Rev. 2018 Oct;41(4):1071-1077. doi: 10.1007/s10143-018-0955-z. Epub 2018 Feb 10.
Craniotomy surgical site infections are an inherent risk and dreaded complication for the elective brain tumor patient. Sequelae can include delays in resumption in adjuvant treatments for multiple surgeries if staged cranioplasty is pursued. Here, the authors review their experience in operative debridement of surgical site infections with single-stage reimplantation of the salvaged craniotomy bone flap. A prospectively maintained database of a single surgeon's neuro-oncology patients from 2009 to 2017 (JRF) was queried to identify 11 patients with surgical site infection after craniotomy for tumor resection. All patients underwent a protocol of aggressive operative debridement including drilling the bone edges and intraoperative flap sterilization with single-stage reimplantation, followed by tailored-antibiotic therapy. Ten of the 11 patients with frankly contaminated bone flaps from surgical site infection were able to be salvaged in a single-stage procedure. Five of these patients underwent adjuvant chemotherapy and/or radiation without secondary complication. There was one treatment failure in a delayed fashion which required additional surgery for craniectomy; however, this occurred after adjuvant treatment was administered. Surgical debridement and bone flap salvage is safe and cost-effective in managing acute surgical site infections after craniotomy for tumors. Additionally, this practice is likely beneficial in expediting the resumption of cancer therapy.
开颅手术部位感染是择期脑肿瘤患者固有的风险和可怕的并发症。如果进行分期颅骨成形术，后遗症可能包括多次手术辅助治疗恢复延迟。在此，作者回顾了他们在手术清创治疗手术部位感染并一期再植入挽救的开颅骨瓣方面的经验。查询了一位外科医生在2009年至2017年期间（JRF）前瞻性维护的神经肿瘤患者数据库，以确定11例肿瘤切除开颅术后发生手术部位感染的患者。所有患者均接受了积极的手术清创方案，包括钻磨骨边缘和术中对骨瓣进行消毒并一期再植入，随后进行针对性抗生素治疗。11例因手术部位感染导致骨瓣明显污染的患者中有10例能够通过一期手术挽救。其中5例患者接受了辅助化疗和/或放疗，无继发并发症。有1例出现延迟性治疗失败，需要再次进行颅骨切除术；然而，这是在给予辅助治疗之后发生的。手术清创和骨瓣挽救在处理肿瘤切除术后急性手术部位感染方面是安全且具有成本效益的。此外，这种做法可能有利于加快癌症治疗的恢复。
