{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:20Z","timestamp":1782107360905,"version":"3.54.5"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cranial infections requiring surgical intervention\u2014whether surgical site infections (SSI) after craniotomy\/craniectomy or spontaneous infections such as subdural empyema and intraparenchymal abscess\u2014pose significant management challenges. We present our 10-year institutional experience treating these cases at a high-volume neurosurgical center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective review of patients \u226518 years old who underwent craniotomy or craniectomy for non-catheter-related cranial infection between 2015 and 2025. Data on demographics, comorbidities, microbiology, surgical management, antibiotic use, revision surgeries, and functional outcomes (mRS at closest available follow-up to 12 months) were collected. Subgroup observations by infection etiology (SSI versus spontaneous) were examined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-three patients (27 men, 16 women; mean age 55.5 years) were included. Cultures were positive in 41\/43 cases, most frequently isolating\n                      <jats:italic>Cutibacterium acnes, Staphylococcus aureus,<\/jats:italic>\n                      and\n                      <jats:italic>Streptococcus intermedius<\/jats:italic>\n                      . The median duration of intravenous antibiotics was 6 weeks. At median 11-month follow-up, 25 of 38 evaluable survivors (65.8%) achieved a good outcome (mRS 0\u20133). Poor outcomes (mRS 4\u20136 or \u22653 revision surgeries) occurred in 13 patients (34.2%) and were associated with higher Charlson Comorbidity Index (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.02) and underlying high-grade glioma or metastatic disease (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.04). Patients with SSI had a higher rate of craniectomy (76.2% vs. 18.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Culture yield remained high regardless of whether broad-spectrum antibiotics were initiated before intraoperative sampling.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This institutional series highlights that infectious involvement of a devascularized bone flap often necessitates craniectomy and increases the revision surgery burden. Functional outcomes were driven primarily by pre-infection comorbidities and underlying aggressive pathology rather than infection etiology alone.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1850910","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:38:50Z","timestamp":1782106730000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical management and functional outcomes of cranial infections requiring craniotomy or craniectomy: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Daniel W.","family":"Griepp","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivum","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heather","family":"Heitkotter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rabia","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avery","family":"Roe","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryce K.","family":"Sarcar","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishan","family":"Perera","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua","family":"Caskey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey P.","family":"Turnbull","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julio","family":"Rosado Philippi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elise J.","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar","family":"Alsalahi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Dragonette","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Henry Ford Health Providence Hospital, Michigan State University College of Human Medicine","place":["Southfield, MI, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna T. 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