Incidence of Recraniotomy for Postoperative Infections After Surgery for Intracranial Tumors

  • Torstein R. Meling
  • Benjamin Lassen
  • Eirik Helseth
Part of the Tumors of the Central Nervous System book series (TCNS, volume 12)


The prevalence rate for all primary brain and central nervous system tumors is estimated to be 130.8 per 100,000 inhabitants (CTBRUS (2008) Statistical report: primary brain tumors in the United States, 2000–2004. The cornerstone of brain tumor treatment is surgery, where the objective is radical surgery within safe limits and to establish an exact tissue diagnosis. However, craniotomies are not without inherent risks, be it surgical mortality, postoperative hematomas or infections. Infections after neurosurgical procedures often present as meningitis, subdural empyema, or cerebral abscess. Although meningitis can often be treated with intravenous antibiotics, cases that involve a bone flap infection, subdural empyema, or cerebral abscess usually require a repeated operation. In a recent large series, 1.5 % of the patients were reoperated for postoperative infection. Of these infections, 59.0 % were extradural. Independent risk factors were male sex and meningioma histopathology. The vast majority of reoperations occurred within 3 months of tumor surgery. The consequences of postoperative infections were generally minor, as 85 % had a good outcome with no or only a mild disability, but within the group of patients reoperated for infection, the mortality rate was 5 %.


Postoperative Infection Central Nervous System Tumor Tumor Surgery Bone Flap Maximum Daily Dose 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Barker FG 2nd (2004) Craniotomy for the resection of metastatic brain tumors in the U.S., 1988–2000: decreasing mortality and the effect of provider caseload. Cancer 100(5):999–1007PubMedCrossRefGoogle Scholar
  2. Blomstedt GC (1985) Infections in neurosurgery: a retrospective study of 1143 patients and 1517 operations. Acta Neurochir (Wien) 78(3–4):81–90CrossRefGoogle Scholar
  3. Chang SM, Parney IF, McDermott M, Barker FG 2nd, Schmidt MH, Huang W, Laws ER Jr, Lillehei KO, Bernstein M, Brem H, Sloan AE, Berger M (2003) Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98(6):1175–1181PubMedCrossRefGoogle Scholar
  4. Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F, Jolesz FA, Black PM (2005) Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 103(6):1227–1233PubMedCrossRefGoogle Scholar
  5. CTBRUS (2008) Statistical report: primary brain tumors in the United States, 2000–2004.
  6. Dashti SR, Baharvahdat H, Spetzler RF, Sauvageau E, Chang SW, Stiefel MF, Park MS, Bambakidis NC (2008) Operative intracranial infection following craniotomy. Neurosurg Focus 24(6):E10PubMedCrossRefGoogle Scholar
  7. Fadul C, Wood J, Thaler H, Galicich J, Patterson RH Jr, Posner JB (1988) Morbidity and mortality of craniotomy for excision of supratentorial gliomas. Neurology 38(9):1374–1379PubMedCrossRefGoogle Scholar
  8. Gerlach R, Raabe A, Scharrer I, Meixensberger J, Seifert V (2004) Post-operative hematoma after surgery for intracranial meningiomas: causes, avoidable risk factors and clinical outcome. Neurol Res 26(1):61–66PubMedCrossRefGoogle Scholar
  9. Hart MG, Grant R, Walker M, Dickinson H (2005) Surgical resection and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases. Cochrane Database Syst Rev 1, CD003292PubMedGoogle Scholar
  10. Idali B, Lahyat B, Khaleq K, Ibahioin K, El Azhari A, Barrou L (2004) Postoperative infection following craniotomy in adults. Med Mal Infect 34(5):221–224PubMedCrossRefGoogle Scholar
  11. Kalfas IH, Little JR (1988) Postoperative hemorrhage: a survey of 4992 intracranial procedures. Neurosurgery 23(3):343–347PubMedCrossRefGoogle Scholar
  12. Keles GE, Chang EF, Lamborn KR, Tihan T, Chang CJ, Chang SM, Berger MS (2006) Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma. J Neurosurg 105(1):34–40PubMedCrossRefGoogle Scholar
  13. Korinek AM (1997) Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidemiologie Hygiene et Prevention. Neurosurgery 41(5):1073–1079PubMedCrossRefGoogle Scholar
  14. Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19(2):155–162PubMedCrossRefGoogle Scholar
  15. Korinek AM, Baugnon T, Golmard JL, van Effenterre R, Coriat P, Puybasset L (2006) Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 59(1):126–133PubMedCrossRefGoogle Scholar
  16. Lassen B, Helseth E, Ronning P, Scheie D, Johannesen TB, Maehlen J, Langmoen IA, Meling TR (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68(5):1259–1268, discussion 1268–9PubMedGoogle Scholar
  17. Lietard C, Thebaud V, Besson G, Lejeune B (2008) Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg 109(4):729–734PubMedCrossRefGoogle Scholar
  18. Mahaley MS Jr, Mettlin C, Natarajan N, Laws ER Jr, Peace BB (1989) National survey of patterns of care for brain-tumor patients. J Neurosurg 71(6):826–836PubMedCrossRefGoogle Scholar
  19. McClelland S 3rd, Hall WA (2007) Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis 45(1):55–59PubMedCrossRefGoogle Scholar
  20. McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, Weingart JD, Brem H, Quinones-Hinojosa AR (2009) Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 110(1):156–162PubMedCrossRefGoogle Scholar
  21. Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL (1985) Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62(1):18–24PubMedCrossRefGoogle Scholar
  22. Mollman HD, Haines SJ (1986) Risk factors for postoperative neurosurgical wound infection. A case–control study. J Neurosurg 64(6):902–906PubMedCrossRefGoogle Scholar
  23. Morokoff AP, Zauberman J, Black PM (2008) Surgery for convexity meningiomas. Neurosurgery 63(3):427–433PubMedCrossRefGoogle Scholar
  24. Nitta T, Sato K (1995) Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. Cancer 75(11):2727–2731PubMedCrossRefGoogle Scholar
  25. Percy AK, Elveback LR, Okazaki H, Kurland LT (1972) Neoplasms of the central nervous system. Epidemiologic considerations. Neurology 22(1):40–48PubMedCrossRefGoogle Scholar
  26. Rabadan AT, Hernandez D, Eleta M, Pietrani M, Baccanelli M, Christiansen S, Teijido C (2007) Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latino-American hospital. Surg Neurol 68(4):412–420, discussion 420PubMedCrossRefGoogle Scholar
  27. Vecht CJ, Avezaat CJ, van Putten WL, Eijkenboom WM, Stefanko SZ (1990) The influence of the extent of surgery on the neurological function and survival in malignant glioma. A retrospective analysis in 243 patients. J Neurol Neurosurg Psychiatry 53(6):466–471PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Torstein R. Meling
    • 1
  • Benjamin Lassen
    • 1
  • Eirik Helseth
    • 1
  1. 1.Department of NeurosuregryOslo University HospitalOsloNorway

Personalised recommendations