A craniotomy is a surgery in which a bone flap is temporarily removed from the Human skull to access the Human brain. Craniotomies are often critical operations, performed on patients who are suffering from brain , such as tumors, blood clots, removal of foreign bodies such as bullets, or traumatic brain injury, and can also allow doctors to surgically implant devices, such as deep brain stimulators for the treatment of Parkinson's disease, epilepsy, and cerebellar tremor. The procedure is also used in epilepsy surgery to remove the parts of the brain that are causing epilepsy.
Craniotomy is distinguished from craniectomy (in which the skull flap is not immediately replaced, allowing the brain to swell, thus reducing intracranial pressure) and from trepanation, the creation of a burr hole through the cranium into the dura mater.
According to the Journal of Neurosurgery, Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis, their clinical studies indicated that "the risk for meningitis was independently associated with perioperative steroid use and ventricular drainage".
Within the 334 procedures that they had conducted from males and females, their results concluded that traumatic brain injuries were the predominant causes of bacterial meningitis.
At least 40% of patients became susceptible to at least one infection, creating more interconnected risk factors along the way. From the Infectious Diseases Clinic Erasme Hospital, there had been reports of infections initially beginning from either the time of surgery, skin intrusion, hematogenous seeding, or retrograde infections.
Cerebrospinal fluid shunt (CSF) associates with the risk of meningitis due to the following factors: pre-shunt associated infections, post-operative CSF leakage, lack of experience from the neurosurgeon, premature birth/young age, advanced age, shunt revisions for dysfunction, and neuroendoscopes.
The way shunts are operated on each patient relies heavily on the cleanliness of the site. Once bacteria penetrates the area of a CSF, the procedure becomes more complicated.
The skin is especially necessary to address because it is an external organ. Scratching the incision site can easily create an infection due to there being no barrier between the open air and wound.
Aside from scratching, decubitus ulcer and tissues near the shunt site are also leading pathways for infection susceptibility.
It is also common to give patients seven days of anti-seizure medications post operatively. Traditionally this has been phenytoin, but now is increasingly levetiracetam as it has a lower risk of drug-drug interactions.
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