Treatment of Craniotomy-Related Bone Flap Osteomyelitis

INTRODUCTION: Cranial bone flap osteomyelitis (BFO) is rare. A few publications relating to postoperative osteomyelitis are available in the literature. In this study, we aim to share our experiences with the clinical management of BFO cases that developed secondary to surgery in the name of contributing to the literature.
METHODS: Forty-four BFO cases that developed secondary to 4582 neurosurgical operations carried out in our clinic between 2011 and 2018 were evaluated. Patients were investigated in terms of demographic attributes, pathogen microorganisms, time that lapsed between the first surgery and development of osteomyelitis, and the cause of the primary surgery. Clinical procedures of patients who developed BFO and were treated by preserving or discarding the bone flap (BF) were studied retrospectively.
RESULTS: A total of 44 patients were followed up due to BFO in our clinic between the years 2011 and 2018. Diagnoses before the first operation were tumor in 18 patients (40.9%), anterior circulation aneurysm in 11 patients (25%), epidural hematoma in 10 patients (22.7%), and chronic subdural haematoma in 5 patients. Regarding to the growth of the culture, microorganisms were grown in 31 cases (31/44) (70.4%) and it could not be grown in culture in 13 patients (13/44) (29.6%). Twenty patients (20/44) (45%) in the study group were treated by debridement+wound irrigation and preserving the BF with antibiotherapy. BF of the remaining 24 patients, on the other hand, were discarded.
DISCUSSION AND CONCLUSION: Surgery-associated osteomyelitis is one of the most undesired complications. BFs are discarded in nearly half of the patients, although the pathogen microorganism is isolated in a great majority of the cases and the appropriate antibiotherapy is applied. BFO treatment becomes more complicated especially due to the close anatomical relation between the frontal and pterional craniotomies and the sinuses.