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Self-Trephination in Cranial Excoriation Disorder.

Coleman P Riordan1, Brittany Owusu-Adjei1,2, Rrita Daci1,2

  • 1Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester , Massachusetts , USA.

Neurosurgery
|June 10, 2024
PubMed
Summary
This summary is machine-generated.

Self-trephination, a rare condition involving self-induced skull holes due to compulsive skin picking, presents a severe neurosurgical emergency. Prompt treatment combining antibiotics, surgery, and psychiatric care is crucial for survival.

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Area of Science:

  • Neurosurgery
  • Psychiatry
  • Dermatology

Background:

  • Self-trephination, the creation of skull holes, is rarely self-inflicted.
  • Excoriation disorder involves compulsive skin picking, potentially leading to severe self-harm.
  • Untreated excoriation disorder poses significant health risks.

Purpose of the Study:

  • Describe patients with self-trephination from cranial excoriation.
  • Review clinical presentation, risk factors, and interventions for self-trephination.
  • Analyze complications, treatments, and mortality associated with this condition.

Main Methods:

  • Case series of 5 patients with self-trephination due to cranial excoriation.
  • Review of clinical characteristics, comorbidities, and treatment outcomes.
  • Analysis of surgical and nonsurgical interventions and their efficacy.

Main Results:

  • Self-trephination involves self-inflicted destruction of scalp and skull, breaching the intracranial compartment.
  • Patients frequently exhibit psychiatric comorbidities and brain injury.
  • Treatment failures are common due to poor adherence.

Conclusions:

  • Self-trephination in cranial excoriation disorder is a life-threatening neuropsychological emergency.
  • Requires immediate antibiotics, surgical debridement, and wound repair.
  • Effective psychiatric management, including antidepressants and behavioral therapy, is essential.