Post-craniotomy infections: A point-by-point approach
Introduction: Post-craniotomy neurosurgical infections (PCNIs) significantly challenge daily neurosurgical practice, affecting patient outcomes and imposing economic burdens on healthcare systems. Despite advances in surgical techniques and infection control protocols, PCNIs still contribute to surg...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425000128 |
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| author | Giovanni Carone Marta Bonada Evelyn Gisell Belotti Eugenia D'Angeli Annica Piccardi Fabio Martino Doniselli Guido Gubertini Cecilia Casali Francesco DiMeco Massimiliano Del Bene |
| author_facet | Giovanni Carone Marta Bonada Evelyn Gisell Belotti Eugenia D'Angeli Annica Piccardi Fabio Martino Doniselli Guido Gubertini Cecilia Casali Francesco DiMeco Massimiliano Del Bene |
| author_sort | Giovanni Carone |
| collection | DOAJ |
| description | Introduction: Post-craniotomy neurosurgical infections (PCNIs) significantly challenge daily neurosurgical practice, affecting patient outcomes and imposing economic burdens on healthcare systems. Despite advances in surgical techniques and infection control protocols, PCNIs still contribute to surgical-related morbidity and mortality. Research question: To address these unresolved questions through a comprehensive literature review. Material and methods: We conducted a detailed literature review using the keywords ''Infection, Craniotomy, Neurosurgery,'' on PubMed, which yielded 2330 articles. Out of these, 171 were selected, based on relevance, and rigorously reviewed. The review aimed to answer thirteen major questions stemming from the management of PCNIs. Results: PCNI incidences range from 0.7% to 8%, predominantly caused by gram-positive bacteria, especially Staphylococcus species. Significant risk factors identified include CSF leakage, emergency surgery, and certain tumour types, with infections typically manifesting post-discharge. Diagnostic approaches integrate clinical, radiological, and laboratory assessments, with advances in molecular diagnostics showing promising precision. While antibiotic prophylaxis remains effective, emerging resistance warrants cautious application. Surgical intervention is often indispensable for managing organ-space infections, with a trend towards bone flap preservation and one-step cranioplasty procedures in certain cases. Discussion and conclusion: The management of PCNIs remains a major challenge. There is a critical need for standardization of definitions and data reporting. Advancements in diagnostic and therapeutic strategies may bring future improvements in clinical outcomes, despite antibiotic resistance phenomena and the complexity of surgical decisions required. Ultimately, major engagement is aimed at refining and updating clinical protocols to improve and standardize the management of PCNIs. |
| format | Article |
| id | doaj-art-abd6f86cb93a4c7db6412ce691c5a2c3 |
| institution | Kabale University |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain and Spine |
| spelling | doaj-art-abd6f86cb93a4c7db6412ce691c5a2c32025-01-31T05:12:45ZengElsevierBrain and Spine2772-52942025-01-015104193Post-craniotomy infections: A point-by-point approachGiovanni Carone0Marta Bonada1Evelyn Gisell Belotti2Eugenia D'Angeli3Annica Piccardi4Fabio Martino Doniselli5Guido Gubertini6Cecilia Casali7Francesco DiMeco8Massimiliano Del Bene9Department of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, ItalyDepartment of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, ItalyDepartment of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, ItalyDepartment of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, ItalyDepartment of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, ItalyNeuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, ItalyInfectious Disease Unit, ASST Fatebenefratelli Sacco, Milan, ItalyDepartment of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, ItalyDepartment of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, Italy; Department of Oncology and Hematology-Oncology, Università Degli Studi di Milano, Milan, Italy; Department of Neurosurgery, Johns Hopkins Medical School, Baltimore, USADepartment of Neurosurgery, IRCCS Carlo Besta Neurological Institute Foundation, Milan, Italy; Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; Corresponding author. Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Italy.Introduction: Post-craniotomy neurosurgical infections (PCNIs) significantly challenge daily neurosurgical practice, affecting patient outcomes and imposing economic burdens on healthcare systems. Despite advances in surgical techniques and infection control protocols, PCNIs still contribute to surgical-related morbidity and mortality. Research question: To address these unresolved questions through a comprehensive literature review. Material and methods: We conducted a detailed literature review using the keywords ''Infection, Craniotomy, Neurosurgery,'' on PubMed, which yielded 2330 articles. Out of these, 171 were selected, based on relevance, and rigorously reviewed. The review aimed to answer thirteen major questions stemming from the management of PCNIs. Results: PCNI incidences range from 0.7% to 8%, predominantly caused by gram-positive bacteria, especially Staphylococcus species. Significant risk factors identified include CSF leakage, emergency surgery, and certain tumour types, with infections typically manifesting post-discharge. Diagnostic approaches integrate clinical, radiological, and laboratory assessments, with advances in molecular diagnostics showing promising precision. While antibiotic prophylaxis remains effective, emerging resistance warrants cautious application. Surgical intervention is often indispensable for managing organ-space infections, with a trend towards bone flap preservation and one-step cranioplasty procedures in certain cases. Discussion and conclusion: The management of PCNIs remains a major challenge. There is a critical need for standardization of definitions and data reporting. Advancements in diagnostic and therapeutic strategies may bring future improvements in clinical outcomes, despite antibiotic resistance phenomena and the complexity of surgical decisions required. Ultimately, major engagement is aimed at refining and updating clinical protocols to improve and standardize the management of PCNIs.http://www.sciencedirect.com/science/article/pii/S2772529425000128Post-craniotomy infectionSurgical site infectionCraniotomyNeurosurgeryProphylactic antibiotic |
| spellingShingle | Giovanni Carone Marta Bonada Evelyn Gisell Belotti Eugenia D'Angeli Annica Piccardi Fabio Martino Doniselli Guido Gubertini Cecilia Casali Francesco DiMeco Massimiliano Del Bene Post-craniotomy infections: A point-by-point approach Brain and Spine Post-craniotomy infection Surgical site infection Craniotomy Neurosurgery Prophylactic antibiotic |
| title | Post-craniotomy infections: A point-by-point approach |
| title_full | Post-craniotomy infections: A point-by-point approach |
| title_fullStr | Post-craniotomy infections: A point-by-point approach |
| title_full_unstemmed | Post-craniotomy infections: A point-by-point approach |
| title_short | Post-craniotomy infections: A point-by-point approach |
| title_sort | post craniotomy infections a point by point approach |
| topic | Post-craniotomy infection Surgical site infection Craniotomy Neurosurgery Prophylactic antibiotic |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425000128 |
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