Frassanito Paolo, Fraschetti Flavia, Bianchi Federico, Giovannenze Francesca, Caldarelli Massimo, Scoppettuolo Giancarlo
Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Childs Nerv Syst. 2019 Sep;35(9):1499-1506. doi: 10.1007/s00381-019-04251-8. Epub 2019 Jun 20.
Infection may complicate the outcome of cranial repair with significant additional morbidity, related to hospitalization, surgery and long antibiotic therapy, that may become even dramatic in case of multi-resistant germs and in particular in the paediatric population. Additionally, the economic costs for the health system are obvious. Moreover, surgical decisions concerning the timing of cranioplasty and choice of the material may be strongly affected by the risk of infection. Despite, management and prevention of cranioplasty infections are not systematically treated through the literature so far.
We reviewed pertinent literature dealing with cranioplasty infection starting from the diagnosis to treatment options, namely conservative versus surgical ones. Our institutional bundle, specific to the paediatric population, is also presented. This approach aims to significantly reduce the risk of infection in first-line cranioplasty and redo cranioplasty after previous infection.
A thorough knowledge and understanding of risk factors may lead to surgical strategies and bundles, aiming to reduce infectious complications of cranioplasty. Finally, innovation in materials used for cranial repair should also aim to enhance the antimicrobial properties of these inert materials.
感染可能会使颅骨修复的结果复杂化，导致与住院、手术及长期抗生素治疗相关的显著额外发病率，在多重耐药菌感染的情况下，尤其是在儿科人群中，情况可能会变得更加严重。此外，对卫生系统的经济成本是显而易见的。此外，关于颅骨成形术时机和材料选择的手术决策可能会受到感染风险的强烈影响。尽管如此，迄今为止，文献中尚未系统地探讨颅骨成形术感染的管理和预防。
我们回顾了从诊断到治疗选择（即保守治疗与手术治疗）等有关颅骨成形术感染的相关文献。我们还介绍了针对儿科人群的机构综合措施。这种方法旨在显著降低初次颅骨成形术和既往感染后再次颅骨成形术的感染风险。
对危险因素的全面了解可能会带来手术策略和综合措施，旨在减少颅骨成形术的感染并发症。最后，用于颅骨修复的材料创新也应旨在增强这些惰性材料的抗菌性能。
