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Child's Nervous System

, Volume 35, Issue 9, pp 1499–1506 | Cite as

Management and prevention of cranioplasty infections

  • Paolo FrassanitoEmail author
  • Flavia Fraschetti
  • Federico Bianchi
  • Francesca Giovannenze
  • Massimo Caldarelli
  • Giancarlo Scoppettuolo
Focus Session
  • 71 Downloads

Abstract

Background

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.

Methods

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.

Conclusions

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.

Keywords

Bundle Cranial repair Cranioplasty Infection Pediatric head injury Prevention Personalized medicine 

Notes

Compliance with ethical standards

Conflict of interest

There are no conflict of interests to disclose.

References

  1. 1.
    Abode-Iyamah KO, Chiang H-Y, Winslow N, Park B, Zanaty M, Dlouhy BJ, Flouty OE, Rasmussen ZD, Herwaldt LA, Greenlee JD (2018) Risk factors for surgical site infections and assessment of vancomycin powder as a preventive measure in patients undergoing first-time cranioplasty. J Neurosurg 128(4):1241–1249CrossRefGoogle Scholar
  2. 2.
    Albanese A, De Bonis P, Sabatino G, Capone G, Marchese E, Vignati A, Maira G (2009) Antibiotic-impregnated ventriculo-peritoneal shunts in patients at high risk of infection. Acta Neurochir 151(10):1259–1263CrossRefGoogle Scholar
  3. 3.
    Auguste KI, McDermott MW (2006) Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients. J Neurosurg 105(4):640–644CrossRefGoogle Scholar
  4. 4.
    Baumeister S, Peek A, Friedman A, Levin LS, Marcus JR (2008) Management of postneurosurgical bone flap loss caused by infection. Plast Reconstr Surg 122(6):195e–208eCrossRefGoogle Scholar
  5. 5.
    Bhaskar IP, Inglis TJJ, Lee GYF (2014) Clinical, radiological, and microbiological profile of patients with autogenous cranioplasty infections. World Neurosurg 82(3–4):e531–e534CrossRefGoogle Scholar
  6. 6.
    Bokhari R, You E, Zeiler FA, Bakhaidar M, Bajunaid K, Lasry O, Baeesa S, Marcoux J (2019) Effect of intrawound vancomycin on surgical site infections in nonspinal neurosurgical procedures: a systematic review and meta-analysis. World Neurosurg 123:409–417.e7CrossRefGoogle Scholar
  7. 7.
    Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA, American Society of Health-System Pharmacists, Infectious Disease Society of America, Surgical Infection Society, Society for Healthcare Epidemiology of America (2013) Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 70(3):195–283CrossRefGoogle Scholar
  8. 8.
    Braxton EE, Ehrlich GD, Hall-Stoodley L, Stoodley P, Veeh R, Fux C, Hu FZ, Quigley M, Post JC (2005) Role of biofilms in neurosurgical device-related infections. Neurosurg Rev 28(4):249–255CrossRefGoogle Scholar
  9. 9.
    Brommeland T, Rydning PN, Pripp AH, Helseth E (2015) Cranioplasty complications and risk factors associated with bone flap resorption. Scand J Trauma Resusc Emerg Med 23:75CrossRefGoogle Scholar
  10. 10.
    Buang SS, Haspani MS (2012) Risk factors for neurosurgical site infections after a neurosurgical procedure: a prospective observational study at Hospital Kuala Lumpur. Med J Malaysia 67(4):393–398Google Scholar
  11. 11.
    Chang V, Hartzfeld P, Langlois M, Mahmood A, Seyfried D (2010) Outcomes of cranial repair after craniectomy. J Neurosurg 112(5):1120–1124CrossRefGoogle Scholar
  12. 12.
    Cheng Y-K, Weng H-H, Yang J-T, Lee M-H, Wang T-C, Chang C-N (2008) Factors affecting graft infection after cranioplasty. J Clin Neurosci 15(10):1115–1119CrossRefGoogle Scholar
  13. 13.
    Chiang H-Y, Kamath AS, Pottinger JM, Greenlee JDW, Howard MA, Cavanaugh JE, Herwaldt LA (2014) Risk factors and outcomes associated with surgical site infections after craniotomy or craniectomy. J Neurosurg 120(2):509–521CrossRefGoogle Scholar
  14. 14.
    Choux M, Genitori L, Lang D, Lena G (1992) Shunt implantation: reducing the incidence of shunt infection. J Neurosurg 77(6):875–880CrossRefGoogle Scholar
  15. 15.
    Conen A, Fux CA, Vajkoczy P, Trampuz A (2017) Management of infections associated with neurosurgical implanted devices. Expert Rev Anti-Infect Ther 15(3):241–255CrossRefGoogle Scholar
  16. 16.
    Coulter IC, Pesic-Smith JD, Cato-Addison WB, Khan SA, Thompson D, Jenkins AJ, Strachan RD, Mukerji N (2014) Routine but risky: a multi-centre analysis of the outcomes of cranioplasty in the northeast of England. Acta Neurochir 156(7):1361–1368CrossRefGoogle Scholar
  17. 17.
    De Bonis P, Frassanito P, Mangiola A, Nucci CG, Anile C, Pompucci A (2012) Cranial repair: how complicated is filling a “hole”? J Neurotrauma 29(6):1071–1076CrossRefGoogle Scholar
  18. 18.
    Feroze AH, Walmsley GG, Choudhri O, Lorenz HP, Grant GA, Edwards MSB (2015) Evolution of cranioplasty techniques in neurosurgery: historical review, pediatric considerations, and current trends. J Neurosurg 123(4):1098–1107CrossRefGoogle Scholar
  19. 19.
    Girgis F, Walcott BP, Kwon C-S, Sheth SA, Asaad W, Nahed BV, Eskandar EN, Coumans J-V (2015) The absence of fever or leukocytosis does not exclude infection following cranioplasty. Can J Neurol Sci 42(4):255–259CrossRefGoogle Scholar
  20. 20.
    Honeybul S, Ho KM (2016) Cranioplasty: morbidity and failure. Br J Neurosurg 30(5):523–528CrossRefGoogle Scholar
  21. 21.
    Hsu VM, Tahiri Y, Wilson AJ, Grady MS, Taylor JA (2014) A preliminary report on the use of antibiotic-impregnated methyl methacrylate in salvage cranioplasty. J Craniofac Surg 25(2):393–396CrossRefGoogle Scholar
  22. 22.
    Hu Y, Li X, Zhao R, Zhang K (2018) Conservative treatment for delayed infection after cranioplasty with titanium alloy. J Craniofac Surg 29(5):1258–1260Google Scholar
  23. 23.
    Iaccarino C, Mattogno PP, Zanotti B, Bellocchi S, Verlicchi A, Viaroli E, Pastorello G, Sgulò F, Ghadirpour R, Servadei F (2018) Septic complication following porous hydroxyapatite cranioplasty: prosthesis retention management. J Neurosurg Sci 62(6):765–772CrossRefGoogle Scholar
  24. 24.
    Jin S-W, Kim S-D, Ha S-K, Lim D-J, Lee H, You H-J (2018) Analysis of the factors affecting surgical site infection and bone flap resorption after cranioplasty with autologous cryopreserved bone: the importance of temporalis muscle preservation. Turk Neurosurg 28(6):882–888Google Scholar
  25. 25.
    Johnson PJ, Robbins DL, Lydiatt WM, Moore GF (2000) Salvage of an infected hydroxyapatite cement cranioplasty with preservation of the implant material. Otolaryngol Head Neck Surg 123(4):515–517CrossRefGoogle Scholar
  26. 26.
    Kim T, Han JH, Kim HB, Song K-H, Kim ES, Kim Y-H, Bang JS, Kim C-Y, Oh CW (2013) Risk factors of surgical site infections after supratentorial elective surgery: a focus on the efficacy of the wound-drain-tip culture. Acta Neurochir 155(11):2165–2170 discussion 2170CrossRefGoogle Scholar
  27. 27.
    Kimchi G, Stlylianou P, Wohl A et al (2016) Predicting and reducing cranioplasty infections by clinical, radiographic and operative parameters - a historical cohort study. J Clin Neurosci 34:182–186CrossRefGoogle Scholar
  28. 28.
    Le C, Guppy KH, Axelrod YV, Hawk MW, Silverthorn J, Inacio MC, Akins PT (2014) Lower complication rates for cranioplasty with peri-operative bundle. Clin Neurol Neurosurg 120:41–44CrossRefGoogle Scholar
  29. 29.
    Lee C-H, Chung YS, Lee SH, Yang H-J, Son Y-J (2012) Analysis of the factors influencing bone graft infection after cranioplasty. J Trauma Acute Care Surg 73(1):255–260CrossRefGoogle Scholar
  30. 30.
    Li A, Azad TD, Veeravagu A, Bhatti I, Long C, Ratliff JK, Li G (2017) Cranioplasty complications and costs: a national population-level analysis using the MarketScan Longitudinal Database. World Neurosurg 102:209–220CrossRefGoogle Scholar
  31. 31.
    Liu H, Dong X, Yin Y, Chen Z, Zhang J (2017) Reduction of surgical site infections after cranioplasty with perioperative bundle. J Craniofac Surg 28(6):1408–1412CrossRefGoogle Scholar
  32. 32.
    Malcolm JG, Mahmooth Z, Rindler RS, Allen JW, Grossberg JA, Pradilla G, Ahmad FU (2018) Autologous Cranioplasty is associated with increased reoperation rate: a systematic review and meta-analysis. World Neurosurg 116:60–68CrossRefGoogle Scholar
  33. 33.
    Matsuno A, Tanaka H, Iwamuro H, Takanashi S, Miyawaki S, Nakashima M, Nakaguchi H, Nagashima T (2006) Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir 148(5):535–540 discussion 540CrossRefGoogle Scholar
  34. 34.
    Meyer RM, Morton RP, Abecassis IJ, Barber JK, Emerson SN, Nerva JD, Ko AL, Chowdhary MC, Levitt MR, Chesnut RM (2017) Risk of complications with simultaneous cranioplasty and placement of ventriculoperitoneal shunt. World Neurosurg 107:830–833CrossRefGoogle Scholar
  35. 35.
    Mustroph CM, Malcolm JG, Rindler RS, Chu JK, Grossberg JA, Pradilla G, Ahmad FU (2017) Cranioplasty infection and resorption are associated with the presence of a ventriculoperitoneal shunt: a systematic review and meta-analysis. World Neurosurg 103:686–693CrossRefGoogle Scholar
  36. 36.
    Oei JD, Zhao WW, Chu L, DeSilva MN, Ghimire A, Rawls HR, Whang K (2012) Antimicrobial acrylic materials with in situ generated silver nanoparticles. J Biomed Mater Res B Appl Biomater 100(2):409–415CrossRefGoogle Scholar
  37. 37.
    Piazza M, Grady MS (2017) Cranioplasty. Neurosurg Clin N Am 28(2):257–265CrossRefGoogle Scholar
  38. 38.
    Reddy S, Khalifian S, Flores JM, Bellamy J, Manson PN, Rodriguez ED, Dorafshar AH (2014) Clinical outcomes in cranioplasty: risk factors and choice of reconstructive material. Plast Reconstr Surg 133(4):864–873CrossRefGoogle Scholar
  39. 39.
    Rocque BG, Agee BS, Thompson EM, Piedra M, Baird LC, Selden NR, Greene S, Deibert CP, Hankinson TC, Lew SM, Iskandar BJ, Bragg TM, Frim D, Grant G, Gupta N, Auguste KI, Nikas DC, Vassilyadi M, Muh CR, Wetjen NM, Lam SK (2018) Complications following pediatric cranioplasty after decompressive craniectomy: a multicenter retrospective study. J Neurosurg Pediatr 22(3):225–232CrossRefGoogle Scholar
  40. 40.
    Rosseto RS, Giannetti AV, de Souza Filho LD, Faleiro RM (2015) Risk factors for graft infection after cranioplasty in patients with large hemicranial bony defects. World Neurosurg 84(2):431–437CrossRefGoogle Scholar
  41. 41.
    Schuss P, Borger V, Güresir Á, Vatter H, Güresir E (2015) Cranioplasty and ventriculoperitoneal shunt placement after decompressive craniectomy: staged surgery is associated with fewer postoperative complications. World Neurosurg 84(4):1051–1054CrossRefGoogle Scholar
  42. 42.
    Still M, Kane A, Roux A, Zanello M, Dezamis E, Parraga E, Sauvageon X, Meder J-F, Pallud J (2018) Independent factors affecting postoperative complication rates after custom-made porous hydroxyapatite cranioplasty: a single-center review of 109 cases. World Neurosurg 114:e1232–e1244CrossRefGoogle Scholar
  43. 43.
    Tamaki T, Eguchi T, Sakamoto M, Teramoto A (2004) Use of diffusion-weighted magnetic resonance imaging in empyema after cranioplasty. Br J Neurosurg 18(1):40–44CrossRefGoogle Scholar
  44. 44.
    Tamburrini G, Massimi L, Caldarelli M, Di Rocco C (2008) Antibiotic impregnated external ventricular drainage and third ventriculostomy in the management of hydrocephalus associated with posterior cranial fossa tumours. Acta Neurochir 150(10):1049–1055 discussion 1055-1056CrossRefGoogle Scholar
  45. 45.
    Tsang AC-O, Hui VK-H, Lui W-M, Leung GK-K (2015) Complications of post-craniectomy cranioplasty: risk factor analysis and implications for treatment planning. J Clin Neurosci 22(5):834–837CrossRefGoogle Scholar
  46. 46.
    van de Vijfeijken SECM, Münker TJAG, Spijker R, Karssemakers LHE, Vandertop WP, Becking AG, Ubbink DT, CranioSafe Group (2018) Autologous bone is inferior to alloplastic cranioplasties: safety of autograft and allograft materials for cranioplasties, a systematic review. World Neurosurg 117:443–452.e8CrossRefGoogle Scholar
  47. 47.
    Yang NR, Song J, Yoon K-W, Seo EK (2018) How early can we perform cranioplasty for traumatic brain injury after decompressive craniectomy? A retrospective multicenter study. World Neurosurg 110:e160–e167CrossRefGoogle Scholar
  48. 48.
    Zanaty M, Chalouhi N, Starke RM et al (2014) Predictors of infections following cranioplasty: a retrospective review of a large single center study. ScientificWorldJournal 2014:356042Google Scholar
  49. 49.
    Zanotti B, Zingaretti N, Verlicchi A, Robiony M, Alfieri A, Parodi PC (2016) Cranioplasty: review of materials. J Craniofac Surg 27(8):2061–2072CrossRefGoogle Scholar
  50. 50.
    Zanotti B, Zingaretti N, Verlicchi A, Alfieri A, Parodi PC (2018) Successful strategies for dealing with infected, custom-made hydroxyapatite cranioplasty. J Craniofac Surg 29(5):1127–1131Google Scholar
  51. 51.
    Zheng W-J, Li L-M, Hu Z-H, Liao W, Lin Q-C, Zhu Y-H, Lin S-H (2018) Excessive hemostasis on the scalp increases superficial surgical site infection rate in cranioplasty. World Neurosurg 120:e811–e817CrossRefGoogle Scholar
  52. 52.
    Zierdt CH (1983) Evidence for transient Staphylococcus epidermidis bacteremia in patients and in healthy humans. J Clin Microbiol 17(4):628–630Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Pediatric NeurosurgeryFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  2. 2.Pediatric NeurosurgeryFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro CuoreRomeItaly
  3. 3.Infectious Diseases UnitFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly

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