Self-Trephination Resulting in Exposed Brain Matter and Cerebral Abscess in a Schizophrenic Patient With Delusions

A 56-year-old woman with schizophrenia presented with persistent foreign body delusions, who chronically excavated her scalp and skull, resulting in a large cranial wound with granulation tissue, purulent discharge, and pneumocephalus. CT scans revealed bilateral subdural hematomas (SDH), polymicrobial osteomyelitis, and a brain abscess causing cerebral edema. The neurosurgical intervention involved cranial washout, debridement, and scalp reconstruction via rotational flap closure, followed by broad-spectrum antibiotics tailored to culture results. Hyperbaric oxygen therapy (HBOT) was employed to promote faster healing and lower postoperative complications and potential reinfection. Psychiatric stabilization with antipsychotics addressed medication noncompliance, improving the patient's engagement with care. Postoperatively, she regained functional independence and was transitioned to inpatient rehabilitation for mobility and activities of daily living. This case highlights the critical role of integrated care involving neurosurgery, psychiatry, infectious disease, and rehabilitation in managing rare and complex presentations of self-trephination. HBOT is noted for its efficacy in promoting healing under challenging conditions.