Our Summary

This research paper looks at bone flap infections (BFIs), which can happen after brain surgery, but are often not properly defined or differentiated from other types of surgical infections. The goal of this study was to look at data from a major adult brain surgery center to better understand some clinical aspects of BFIs, and to help improve how they are defined, classified, and monitored.

The researchers looked back at data on samples taken from patients who were suspected of having a BFI, and also looked at information from national and local databases for evidence of BFIs or related conditions. They looked for single and multiple microbial infections that were related to the surgical site.

From 2016 to 2020, they found 63 patients who had a mean age of 45 years. The most common term used to describe BFI in the data was “craniectomy for infection of the skull,” but there were other terms used as well. The most common reason for needing this surgery was a malignant tumor, in 44% of cases. The samples submitted for testing included bone flaps, fluid/pus, and tissues. Ninety-two percent of patients had at least one positive culture result; 55% were single microbial and 45% were multiple microbial. Gram-positive bacteria were the most common, with Staphylococcus aureus being the most common.

The study concludes that there needs to be better clarity on how to define BFIs, to improve how they are classified and monitored. This will help develop better prevention strategies and improve patient care.

FAQs

  1. What is a bone flap infection (BFI)?
  2. What are the most common types of bacteria found in bone flap infections following a craniotomy?
  3. Why is there a need for greater clarity in defining bone flap infections?

Doctor’s Tip

One helpful tip a doctor might tell a patient about craniotomy is to closely follow post-operative care instructions to reduce the risk of infection. This may include keeping the incision site clean and dry, taking prescribed antibiotics as directed, and watching for signs of infection such as redness, swelling, or drainage. It is also important to attend all follow-up appointments with your healthcare provider to ensure proper healing and monitor for any complications.

Suitable For

Patients who are typically recommended craniotomy are those with underlying conditions such as malignant neoplasms that necessitate the procedure. In this study, the most common underlying condition necessitating craniectomy was a malignant neoplasm in 44% of cases. Other patients who may be recommended craniotomy include those with suspected bone flap infections, as highlighted in the study. Additionally, patients with other neurological conditions such as brain tumors, traumatic brain injuries, and vascular malformations may also be recommended craniotomy for surgical intervention.

Timeline

Before craniotomy:

  • Patient may experience symptoms related to the underlying condition necessitating the surgery, such as headaches, seizures, or cognitive changes.
  • Patient undergoes pre-operative testing and evaluation to assess their overall health and readiness for surgery.
  • Patient meets with their neurosurgeon to discuss the procedure, risks, and potential outcomes.
  • Patient may need to undergo additional imaging studies to further evaluate the area of the brain requiring surgery.

After craniotomy:

  • Patient is monitored closely in the intensive care unit or recovery room for immediate post-operative care.
  • Patient may experience pain, swelling, and discomfort at the surgical site.
  • Patient may have a drain placed to help remove excess fluid from the surgical site.
  • Patient may need to stay in the hospital for several days to monitor for any complications or infections.
  • Patient will follow up with their neurosurgeon for post-operative care and monitoring, including imaging studies to assess healing and recovery.
  • Patient may need rehabilitation therapy to help with recovery and regain function.

What to Ask Your Doctor

  1. What is a craniotomy and why is it necessary in my case?
  2. What are the risks and potential complications associated with a craniotomy, including bone flap infections?
  3. How can I reduce my risk of developing a bone flap infection after surgery?
  4. What symptoms should I watch out for that may indicate a bone flap infection?
  5. How will a bone flap infection be diagnosed and treated if it occurs?
  6. What is the typical recovery process following a craniotomy, and how might a bone flap infection affect this?
  7. Will I need any additional monitoring or follow-up care specifically related to the risk of bone flap infection?
  8. Are there any specific lifestyle changes I should make to reduce my risk of infection after surgery?
  9. How common are bone flap infections following craniotomy procedures, and what is the prognosis for patients who develop them?
  10. Are there any alternative treatment options or strategies that could help reduce my risk of a bone flap infection during or after surgery?

Reference

Authors: O’Donnell S, Creedon M, Walsh J, Dinesh B, O’Brien DP, MacNally S, Humphreys H. Journal: J Hosp Infect. 2023 Jun;136:14-19. doi: 10.1016/j.jhin.2023.03.019. Epub 2023 Mar 31. PMID: 37004785