{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T12:45:14Z","timestamp":1793277914567,"version":"4.5.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Neurochir"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>For post-craniotomy surgical site infection (SSI) involving the bone, typical management involves removal of the bone flap and delayed cranioplasty. The disadvantages of delayed cranioplasty include cosmetic deformity, vulnerability of unprotected brain, skin contraction, syndrome of the trephined and the risks of further surgery. Second procedures also add to cost due to surgical time, hospital stay, and opportunity costs for patients from being away from work.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We retrospectively reviewed patients who underwent post-craniotomy bone flap removal due to SSI, with immediate titanium mesh cranioplasty. The primary outcome was re-operation due to persistent infection or wound healing complications. The secondary outcome was re-operation due to unacceptable cosmetic result.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Nineteen patients were included between 2018 to 2024. Two patients required additional debridement and removal of the titanium mesh due to persistent infection. Another patient had the plate replaced with PEEK due to poor skin quality, wound breakdown and an unacceptable cosmetic result. Two further patients with bifrontal craniotomies had the mesh replaced for cosmetic reasons. Fourteen patients had long term resolution with no further procedure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Immediate TM insertion at the time of bone flap removal is an acceptable option in the management of post-craniotomy SSI. It seems the overall complication rate is comparable to delayed titanium cranioplasty, with the benefit of avoiding the risks and costs of a second operation. Cosmetic results are worse with larger defects, but these patients can still benefit from early TM placement by making operative conditions easier when the custom made, delayed cranioplasty is inserted.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00701-025-06509-4","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T06:07:55Z","timestamp":1749017275000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Immediate titanium mesh cranioplasty after debridement of post-craniotomy infection"],"prefix":"10.1007","volume":"167","author":[{"given":"Micaela","family":"Uberti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Navneet","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"issue":"4","key":"6509_CR1","doi-asserted-by":"publisher","first-page":"640","DOI":"10.3171\/jns.2006.105.4.640","volume":"105","author":"KI Auguste","year":"2006","unstructured":"Auguste KI, McDermott MW (2006) Salvage of infected craniotomy bone flaps with the wash-in, wash-out indwelling antibiotic irrigation system. Technical note and case series of 12 patients. J Neurosurg 105(4):640\u2013644","journal-title":"J Neurosurg"},{"issue":"6","key":"6509_CR2","doi-asserted-by":"publisher","first-page":"1203","DOI":"10.3171\/jns.2003.98.6.1203","volume":"98","author":"JN Bruce","year":"2003","unstructured":"Bruce JN, Bruce SS (2003) Preservation of bone flaps in patients with postcraniotomy infections. J Neurosurg 98(6):1203\u20131207","journal-title":"J Neurosurg"},{"issue":"6","key":"6509_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3171\/2009.3.FOCUS091","volume":"26","author":"M Cabraja","year":"2009","unstructured":"Cabraja M, Klein M, Lehmann TN (2009) Long-term results following titanium cranioplasty of large skull defects. Neurosurg Focus 26(6):1\u20137","journal-title":"Neurosurg Focus"},{"issue":"2","key":"6509_CR4","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1016\/S1130-1473(09)70179-4","volume":"20","author":"PD Delgado-L\u00f3pez","year":"2009","unstructured":"Delgado-L\u00f3pez PD, Mart\u00edn-Velasco V, Castilla-D\u00edez JM, Galacho-Harriero AM, Rodr\u00edguez-Salazar A (2009) Preservation of bone flap after craniotomy infection. Neurocirugia 20(2):124\u2013131","journal-title":"Neurocirugia"},{"key":"6509_CR5","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1016\/j.wneu.2016.12.011","volume":"99","author":"G Ehrlich","year":"2017","unstructured":"Ehrlich G, Kindling S, Wenz H, H\u00e4nggi D, Schulte DM, Schmiedek P, Seiz-Rosenhagen M (2017) Immediate titanium mesh implantation for patients with postcraniotomy neurosurgical site infections: safe and aesthetic alternative procedure? World Neurosurg 99:491\u2013499","journal-title":"World Neurosurg"},{"issue":"6","key":"6509_CR6","doi-asserted-by":"publisher","first-page":"832","DOI":"10.3109\/02688697.2012.692839","volume":"26","author":"CS Hill","year":"2012","unstructured":"Hill CS, Luoma AMV, Wilson SR, Kitchen N (2012) Titanium cranioplasty and the prediction of complications. Br J Neurosurg 26(6):832\u2013837","journal-title":"Br J Neurosurg"},{"issue":"1 Suppl Operati","key":"6509_CR7","first-page":"8","volume":"70","author":"VR Kshettry","year":"2012","unstructured":"Kshettry VR, Hardy S, Weil RJ, Angelov L, Barnett GH (2012) Immediate titanium cranioplasty after debridement and craniectomy for postcraniotomy surgical site infection. Neurosurgery 70(1 Suppl Operative):8\u201315","journal-title":"Neurosurgery"},{"issue":"2","key":"6509_CR8","first-page":"287","volume":"50","author":"A Larsson","year":"2002","unstructured":"Larsson A, Engstr\u00f6m M, Uusij\u00e4rvi J, Kihlstr\u00f6m L, Lind F, Mathiesen T (2002) Hyperbaric oxygen treatment of postoperative neurosurgical infections. Neurosurgery 50(2):287\u2013295","journal-title":"Neurosurgery"},{"issue":"5","key":"6509_CR9","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s00701-006-0740-6","volume":"148","author":"A Matsuno","year":"2006","unstructured":"Matsuno A, Tanaka H, Iwamuro H, Takanashi S, Miyawaki S, Nakashima M, Nakaguchi H, Nagashima T (2006) Analyses of the factors influencing bone graft infection after delayed cranioplasty. Acta Neurochir (Wien) 148(5):535\u2013540","journal-title":"Acta Neurochir (Wien)"},{"issue":"5","key":"6509_CR10","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1007\/s00701-014-2024-x","volume":"156","author":"S Mukherjee","year":"2014","unstructured":"Mukherjee S, Thakur B, Haq I, Hettige S, Martin AJ (2014) Complications of titanium cranioplasty - A retrospective analysis of 174 patients. Acta Neurochir (Wien) 156(5):989\u2013998","journal-title":"Acta Neurochir (Wien)"},{"key":"6509_CR11","doi-asserted-by":"publisher","first-page":"e493","DOI":"10.1016\/j.wneu.2022.12.057","volume":"171","author":"T Potter","year":"2023","unstructured":"Potter T, Murayi R, Ahorukomeye P et al (2023) Immediate titanium mesh cranioplasty after debridement and craniectomy for postcraniotomy surgical site infections and risk factors for reoperation. World Neurosurg 171:e493\u2013e499","journal-title":"World Neurosurg"},{"key":"6509_CR12","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.wneu.2023.01.084","volume":"173","author":"N Sadhwani","year":"2023","unstructured":"Sadhwani N, Garg K, Kumar A, Agrawal D, Singh M, Chandra PS, Kale SS (2023) Comparison of infection rates following immediate and delayed cranioplasty for postcraniotomy surgical site infections: results of a meta-analysis. World Neurosurg 173:167-175.e2","journal-title":"World Neurosurg"},{"issue":"5","key":"6509_CR13","doi-asserted-by":"publisher","first-page":"1404","DOI":"10.1097\/SCS.0000000000006488","volume":"31","author":"AA Talwar","year":"2020","unstructured":"Talwar AA, Bhat DK, Heiman AJ, Ricci JA (2020) Outcomes of immediate titanium cranioplasty following post-craniotomy infection. J Craniofac Surg 31(5):1404\u20131407","journal-title":"J Craniofac Surg"},{"key":"6509_CR14","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1227\/NEU.0b013e31827b98f3","volume":"72","author":"A Wiggins","year":"2013","unstructured":"Wiggins A, Austerberry R, Morrison D, Ho KM, Honeybul S (2013) Cranioplasty with custom-made titanium plates\u201314 years experience. Neurosurgery 72:248\u2013256","journal-title":"Neurosurgery"},{"issue":"2","key":"6509_CR15","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1227\/NEU.0b013e31827b98f3","volume":"72","author":"A Wiggins","year":"2013","unstructured":"Wiggins A, Austerberry R, Morrison D, Ho KM, Honeybul S (2013) Cranioplasty with custom-made titanium plates-14 years experience. Neurosurgery 72(2):248\u2013256","journal-title":"Neurosurgery"},{"issue":"1","key":"6509_CR16","doi-asserted-by":"publisher","first-page":"207.e11","DOI":"10.1016\/j.wneu.2011.02.013","volume":"79","author":"JJ Wind","year":"2013","unstructured":"Wind JJ, Ohaegbulam C, Iwamoto FM, Black PM, Park JK (2013) Immediate titanium mesh cranioplasty for treatment of postcraniotomy infections. World Neurosurg 79(1):207.e11-207.e13","journal-title":"World Neurosurg"}],"container-title":["Acta Neurochirurgica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06509-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00701-025-06509-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00701-025-06509-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T06:08:03Z","timestamp":1749017283000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00701-025-06509-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["6509"],"URL":"https:\/\/doi.org\/10.1007\/s00701-025-06509-4","relation":{},"ISSN":["0942-0940"],"issn-type":[{"value":"0942-0940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]},"assertion":[{"value":"17 February 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 March 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 June 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"161"}}