Frontiers in surgery · 2026
Surgical management and functional outcomes of cranial infections requiring craniotomy or craniectomy: a retrospective cohort study.
СтатьяНазвание и аннотация: Перевод в очереди
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Griepp Daniel W, Desai Shivum, Heitkotter Heather, Ahmed Rabia, Roe Avery, Sarcar Bryce K, Perera Ishan, Caskey Joshua, Turnbull Jeffrey P, Rosado Philippi Julio, Yoon Elise J, Alsalahi Ammar, Dragonette James, Griepp Anna T K, Houseman Clifford M, Kelkar Prashant, Claus Chad F, Richards Boyd F, Carr Daniel A
Аннотация
INTRODUCTION: Cranial infections requiring surgical intervention-whether surgical site infections (SSI) after craniotomy/craniectomy or spontaneous infections such as subdural empyema and intraparenchymal abscess-pose significant management challenges. We present our 10-year institutional experience treating these cases at a high-volume neurosurgical center.
METHODS: Retrospective review of patients ≥18 years old who underwent craniotomy or craniectomy for non-catheter-related cranial infection between 2015 and 2025. Data on demographics, comorbidities, microbiology, surgical management, antibiotic use, revision surgeries, and functional outcomes (mRS at closest available follow-up to 12 months) were collected. Subgroup observations by infection etiology (SSI versus spontaneous) were examined.
RESULTS: Forty-three patients (27 men, 16 women; mean age 55.5 years) were included. Cultures were positive in 41/43 cases, most frequently isolating Cutibacterium acnes, Staphylococcus aureus, and Streptococcus intermedius. The median duration of intravenous antibiotics was 6 weeks. At median 11-month follow-up, 25 of 38 evaluable survivors (65.8%) achieved a good outcome (mRS 0-3). Poor outcomes (mRS 4-6 or ≥3 revision surgeries) occurred in 13 patients (34.2%) and were associated with higher Charlson Comorbidity Index (p < 0.02) and underlying high-grade glioma or metastatic disease (p = 0.04). Patients with SSI had a higher rate of craniectomy (76.2% vs. 18.2%, p < 0.001). Culture yield remained high regardless of whether broad-spectrum antibiotics were initiated before intraoperative sampling.
CONCLUSION: This institutional series highlights that infectious involvement of a devascularized bone flap often necessitates craniectomy and increases the revision surgery burden. Functional outcomes were driven primarily by pre-infection comorbidities and underlying aggressive pathology rather than infection etiology alone.
METHODS: Retrospective review of patients ≥18 years old who underwent craniotomy or craniectomy for non-catheter-related cranial infection between 2015 and 2025. Data on demographics, comorbidities, microbiology, surgical management, antibiotic use, revision surgeries, and functional outcomes (mRS at closest available follow-up to 12 months) were collected. Subgroup observations by infection etiology (SSI versus spontaneous) were examined.
RESULTS: Forty-three patients (27 men, 16 women; mean age 55.5 years) were included. Cultures were positive in 41/43 cases, most frequently isolating Cutibacterium acnes, Staphylococcus aureus, and Streptococcus intermedius. The median duration of intravenous antibiotics was 6 weeks. At median 11-month follow-up, 25 of 38 evaluable survivors (65.8%) achieved a good outcome (mRS 0-3). Poor outcomes (mRS 4-6 or ≥3 revision surgeries) occurred in 13 patients (34.2%) and were associated with higher Charlson Comorbidity Index (p < 0.02) and underlying high-grade glioma or metastatic disease (p = 0.04). Patients with SSI had a higher rate of craniectomy (76.2% vs. 18.2%, p < 0.001). Culture yield remained high regardless of whether broad-spectrum antibiotics were initiated before intraoperative sampling.
CONCLUSION: This institutional series highlights that infectious involvement of a devascularized bone flap often necessitates craniectomy and increases the revision surgery burden. Functional outcomes were driven primarily by pre-infection comorbidities and underlying aggressive pathology rather than infection etiology alone.