Surgical Site Infections in Cranial Surgery

Abstract

Surgical site infections (SSIs) following cranial surgery remain a serious clinical problem and major causes of morbidity and mortality. Classically, SSIs are divided into extradural and intradural infections. Risk factors can be categorized as patient related or procedure related. Clinical symptoms vary greatly depending on many features, with the most common being fever, local wound inflammation, purulent drainage, headache, mental status change, seizure, and focal neurologic deficits. CT scanning and MRI offer an interesting basis for the diagnosis of cranial and intracranial infections. Inflammatory biomarkers are highly variable in their expression in the postoperative period, with the most useful being C-reactive protein (CRP) and procalcitonin levels. When possible, CSF should be evaluated in patients with suspected intradural infections. The most common causative pathogens are quite similar, dominated by gram-positive skin flora, especially Staphylococcus aureus. Patients with limited infections may be managed with local measures and antimicrobial therapy alone, but these selected cases require careful monitoring and should be considered for surgery if complications arise. Abscess, empyema, and large cranial osteomyelitis require reoperation with cleaning, evacuation of fluids, debridement, removal of foreign material, drainage, and careful wound closure. Strict awareness of hygiene, with careful application of protocols, decreases SSIs. If treated rapidly and vigorously, SSIs may resolve without sequelae, but many neurologic complications may occur, especially in patients with intradural infections.