Artikel
Immediate titanium mesh implantation for patients with postcraniotomy neurosurgical site infections: an elegant, safe and esthetic alternative
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Surgical site infection (SSI) is one of the main complications after craniotomy. The incidence is up to 11% in the literature. The established procedure is craniectomy, debridement and delayed cranioplasty. Delayed cranioplasty has several disadvantages such as cosmetic deformity, vulnerability of the unprotected brain and need for a second operation with all medical and surgical risks. A promising approach may be the immediate titanium mesh cranioplasty at the time of wound revision. Therefore we report on our experiences with this technique with emphasis on reinfection rate and patient satisfaction.
Method: Patients treated in our department between 01/2013 to 10/2014 with SSI after craniotomy for brain tumor, trauma or vascular pathologies, were prospectively collected. In all these patients immediate titanium mesh implantation after craniectomy and debridement followed by antibiotic therapy was performed. The primary outcome parameters were re-infection rate and patient satisfaction via self-designed questionnaires during a follow-up period of more than 3 months.
Results: 24 patients could be included. Main risk factors, causing SSI, were previous steroid medication (62,5%), prior cranial radiation (42%), postoperative CSF leak (12,5%) and diabetes (25%). The follow-up was > 3 months after titanium mesh cranioplasty (mean 4,6 months; range 3 - 6 months). In all patients (100%) no recurrent infection was detected. In 2 cases a re-operation was necessary, due to hydrocephalus and persistent CSF fistula. In both cases there was no evidence for recurrent infection. The returned questionnaires showed a high satisfaction rate with the cosmetic result.
Conclusions: Our small series seems to confirm the hypothesis that immediate titanium mesh implantation for patients with postcraniotomy SSI is feasible, cost-effective and might be an alternative to delayed cranioplasty.