{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:58:26Z","timestamp":1786125506711,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND IMPORTANCE:<\/jats:title>\n                    <jats:p>Trephination is a procedure in which a small hole is made in the skull. Rare cases of self-trephination by individuals seeking medical benefit have been reported. Excoriation disorder is a compulsive skin-picking condition in which an individual self-inflicts cutaneous lesions. Left untreated, severe excoriation disorder can pose significant health risks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CLINICAL PRESENTATION:<\/jats:title>\n                    <jats:p>Here, we describe 5 patients who presented with self-trephination due to a severe form of compulsive cranial excoriation at 2 neighboring academic medical centers over a 4-year period. We review the clinical presentation of self-trephination in cranial excoriation disorder and associated risk factors, surgical and nonsurgical interventions, complications of the disease, treatments, and mortality. Defining clinical characteristics include repetitive self-induced destruction of the scalp and skull with entry into the intracranial compartment, frequent psychiatric comorbidities, infection or injury of the brain with consequent neurological morbidity or mortality, and frequent treatment failures because of poor adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>Self-trephination in cranial excoriation disorder is a severe neuropsychological disorder and neurosurgical emergency that exposes the brain and is often life-threatening. Appropriate therapy requires antibiotics, surgical debridement and repair of the wound, and concomitant effective psychiatric management of the underlying compulsion, including the use of antidepressants and behavioral therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1227\/neu.0000000000003004","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T09:01:04Z","timestamp":1718010064000},"page":"e161-e166","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Self-Trephination in Cranial Excoriation Disorder"],"prefix":"10.1227","volume":"95","author":[{"given":"Coleman P.","family":"Riordan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-3695-3173","authenticated-orcid":false,"given":"Brittany","family":"Owusu-Adjei","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"},{"name":"UMass Memorial Health, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rrita","family":"Daci","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"},{"name":"UMass Memorial Health, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alannah","family":"Phelan","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constance J.","family":"Mietus","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"},{"name":"UMass Memorial Health, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Kosarchuk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Lambert","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"},{"name":"UMass Memorial Health, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanya M.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"},{"name":"UMass Memorial Health, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeewoo Chelsea","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Mihalek","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Sorour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Homsy","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Tufts University Medical Center, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kryzanski","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Tufts University Medical Center, Boston, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Aulet","sequence":"additional","affiliation":[{"name":"UMass Memorial Health, Worcester, Massachusetts, USA;"},{"name":"Department of Otolaryngology, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark D.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA;"},{"name":"UMass Memorial Health, Worcester, Massachusetts, USA;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,6,10]]},"reference":[{"issue":"7","key":"R1-20250819","doi-asserted-by":"crossref","first-page":"454","DOI":"10.4088\/JCP.v60n0707","article-title":"Self-injurious skin picking: clinical characteristics and comorbidity","volume":"60","author":"Wilhelm","year":"1999","journal-title":"J Clin Psychiatry."},{"key":"R3-20250819","doi-asserted-by":"crossref","first-page":"1867","DOI":"10.2147\/NDT.S121138","article-title":"Excoriation (skin-picking) disorder: a systematic review of treatment options","volume":"13","author":"Lochner","year":"2017","journal-title":"Neuropsychiatr Dis Treat."},{"key":"R4-20250819","doi-asserted-by":"crossref","first-page":"152338","DOI":"10.1016\/j.comppsych.2022.152338","article-title":"Characteristics of 262 adults with skin picking disorder","volume":"117","author":"Grant","year":"2022","journal-title":"Compr Psychiatry."},{"issue":"6","key":"R5-20250819","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1016\/j.clindermatol.2018.08.008","article-title":"Assessment and treatment of trichotillomania (hair pulling disorder) and excoriation (skin picking) disorder","volume":"36","author":"Jones","year":"2018","journal-title":"Clin Dermatol."},{"issue":"12","key":"R6-20250819","doi-asserted-by":"crossref","first-page":"e1132","DOI":"10.1097\/GOX.0000000000001132","article-title":"Management of a complex excoriation disorder-induced wound with a viable cryopreserved placental membrane","volume":"4","author":"Bain","year":"2016","journal-title":"Plast Reconstr Surg Glob Open."},{"issue":"3","key":"R7-20250819","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1097\/SCS.0000000000001514","article-title":"The reconstructive challenges and approach to patients with excoriation disorder","volume":"26","author":"Galdyn","year":"2015","journal-title":"J Craniofac Surg."},{"issue":"8","key":"R8-20250819","doi-asserted-by":"crossref","first-page":"e814","DOI":"10.1097\/SCS.0000000000009717","article-title":"Reconstruction of scalp wounds in patients with excoriation disorder","volume":"34","author":"Bahraini","year":"2023","journal-title":"J Craniofac Surg."},{"key":"R9-20250819","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.jpsychires.2020.06.033","article-title":"Prevalence of skin picking (excoriation) disorder","volume":"130","author":"Grant","year":"2020","journal-title":"J Psychiatr Res."},{"issue":"8","key":"R10-20250819","doi-asserted-by":"crossref","first-page":"775","DOI":"10.2174\/1570159X17666190320164223","article-title":"Drug treatment of trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder, and nail-biting (onychophagia)","volume":"17","author":"Sani","year":"2019","journal-title":"Curr Neuropharmacol."},{"key":"R11-20250819","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.genhosppsych.2016.04.001","article-title":"A systematic review and meta-analysis of psychiatric treatments for excoriation (skin-picking) disorder","volume":"41","author":"Selles","year":"2016","journal-title":"Gen Hosp Psychiatry."},{"issue":"5","key":"R12-20250819","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1001\/jamapsychiatry.2016.0060","article-title":"N-acetylcysteine in the treatment of excoriation disorder: a randomized clinical trial","volume":"73","author":"Grant","year":"2016","journal-title":"JAMA Psychiatry."},{"issue":"7","key":"R13-20250819","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1177\/10600280221138092","article-title":"\u201cN-acetylcysteine for obsessive-compulsive and related disorders in children and adolescents: a review\u201d","volume":"57","author":"Parli","year":"2022","journal-title":"Ann Pharmacother."},{"issue":"12","key":"R14-20250819","doi-asserted-by":"crossref","first-page":"925","DOI":"10.4088\/JCP.v62n1202","article-title":"Improvement in severe self-mutilation following limbic leucotomy: a series of 5 consecutive cases","volume":"62","author":"Price","year":"2001","journal-title":"J Clin Psychiatry."},{"issue":"6","key":"R15-20250819","doi-asserted-by":"crossref","first-page":"1071","DOI":"10.1227\/00006123-199606000-00001","article-title":"Magnetic resonance image-guided stereotactic cingulotomy for intractable psychiatric disease","volume":"38","author":"Spangler","year":"1996","journal-title":"Neurosurgery."},{"issue":"4","key":"R16-20250819","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1159\/000348275","article-title":"Long-term efficacy of stereotactic bilateral anterior cingulotomy and bilateral anterior capsulotomy as a treatment for refractory obsessive-compulsive disorder","volume":"91","author":"Zhang","year":"2013","journal-title":"Stereotact Funct Neurosurg."},{"issue":"1","key":"R17-20250819","doi-asserted-by":"crossref","first-page":"77","DOI":"10.3171\/2015.1.JNS14681","article-title":"Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies","volume":"124","author":"Brown","year":"2016","journal-title":"J Neurosurg."},{"issue":"6","key":"R18-20250819","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1093\/neuros\/nyy536","article-title":"An international radiosurgery research foundation multicenter retrospective study of gamma ventral capsulotomy for obsessive compulsive disorder","volume":"85","author":"Gupta","year":"2019","journal-title":"Neurosurgery."},{"issue":"1","key":"R19-20250819","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1038\/s41380-020-00933-x","article-title":"Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?","volume":"26","author":"Wu","year":"2021","journal-title":"Mol Psychiatry."},{"key":"R20-20250819","doi-asserted-by":"crossref","first-page":"797533","DOI":"10.3389\/fnint.2022.797533","article-title":"The evolution of modern ablative surgery for the treatment of obsessive-compulsive and major depression disorders","volume":"16","author":"Mustroph","year":"2022","journal-title":"Front Integr Neurosci."},{"issue":"5","key":"R21-20250819","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.biopsych.2017.11.034","article-title":"Gamma ventral capsulotomy in intractable obsessive-compulsive disorder","volume":"84","author":"Rasmussen","year":"2018","journal-title":"Biol Psychiatry."},{"issue":"6","key":"R22-20250819","doi-asserted-by":"crossref","first-page":"1128","DOI":"10.1093\/neuros\/nyab050","article-title":"Magnetic resonance imaging-guided laser thermal ventral capsulotomy for intractable obsessive-compulsive disorder","volume":"88","author":"McLaughlin","year":"2021","journal-title":"Neurosurgery."}],"container-title":["Neurosurgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1227\/neu.0000000000003004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T16:56:44Z","timestamp":1786121804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1227\/neu.0000000000003004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,10]]},"references-count":21,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.1227\/neu.0000000000003004","relation":{},"ISSN":["0148-396X","1524-4040"],"issn-type":[{"value":"0148-396X","type":"print"},{"value":"1524-4040","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,10]]},"assertion":[{"value":"2023-11-29","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-29","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}