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. 2025 Jan 23:5:104193.
doi: 10.1016/j.bas.2025.104193. eCollection 2025.

Post-craniotomy infections: A point-by-point approach

Giovanni Carone  1 , Marta Bonada  1 , Evelyn Gisell Belotti  1 , Eugenia D'Angeli  1 , Annica Piccardi  1 , Fabio Martino Doniselli  2   3 , Guido Gubertini  4 , Cecilia Casali  1 , Francesco DiMeco  1   5   6 , Massimiliano Del Bene  1   7   8
Affiliations

Post-craniotomy infections: A point-by-point approach

Giovanni Carone et al. Brain Spine. .

Abstract

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.

Keywords: Craniotomy; Neurosurgery; Post-craniotomy infection; Prophylactic antibiotic; Surgical site infection.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Acknowledgement This work was supported/partially supported by the Italian Ministry of Health (RRC).

Figures

Fig. 1
Fig. 1
Prisma diagram.
Fig. 2
Fig. 2
Flowchart of our proposed management and treatment protocol.
See this image and copyright information in PMC

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