Prolonged and intermittent discharges from surgical sites in patients with history of craniotomy: Delayed diagnosis

Abstract

Listen

Translate article

This study aims to evaluate characteristics of delayed and prolonged surgical site discharges and their prognostic significance after craniotomies. Postoperative infections after craniotomy are potentially serious complications warranting vigilance and intervention. Prolonged and delayed surgical site discharge is an overlooked and seldomly reported entity in the neurosurgical literature. We have treated several cases with prolonged discharges from their craniotomy sites in a delayed fashion even years after their surgeries. The tertiary referral center database was reviewed for cases involving surgical site discharges. We found 164 cases of infection following neurosurgical procedures between 2010 and 2020, of which nine involved discharges. Four of these patients were excluded upon the second evaluation, and finally, five cases were included for further analysis. Our cohort comprised three females and two males aged 13–46 years (mean: 28.8 years). The initial surgeries were performed a mean of 61.2 months ago. Subtle discharges from surgical sites began as early as 1 month or as late as 15.5 years following surgery. The culture results implicated Pseudomonas aeruginosa in one case, coagulase-negative Staphylococcus in one, and normal skin flora in two. One case was inconclusive. All patients were operated on, and the surgical site was irrigated. In two patients, the bone flap and the cranioplasty material were also removed. The patients were followed up for a mean 40.8 months and there were no further discharges from the surgical site. Non-purulent, sticky discharges from surgical sites are an overlooked entity in neurosurgical practice. Recognition and familiarity with the natural course of this condition can make earlier exploration of the surgical site possible, with favorable outcomes compared to long-term antibiotic therapy.