Risk factors for post-craniotomy intracranial infections: a retrospective analysis of 742 cases

Intracranial infection, as a complication of craniotomy, has a relatively low incidence rate. However, completely preventing post-craniotomy intracranial infections (PCI) remains challenging. Although established protocols exist for managing PCI, patients with severe infections still face risks of disability and mortality. This study aims to analyze high-risk factors for intracranial infections after craniotomy and explore preventive and management strategies to provide guidance for clinical practice.

The authors retrospectively analyzed clinical data from 742 patients who underwent craniotomy between July 2018 and December 2024. 31 cases of PCI were included in the case group, while 711 non-infected cases served as the control group. Demographic, clinical, laboratory, and surgical data were compared between the two groups. Univariate analysis and binary logistic regression models were used to identify risk factors for intracranial infection.

In this study, the incidence of PCI in the authors' neurosurgery department was 4.18%. The infection group showed significantly higher rates of prolonged hospitalization, cerebrospinal fluid (CSF) leakage, intensive care unit (ICU) admission, elevated C-reactive protein (CRP) levels, American Society of Anesthesiology (ASA) class > 3, infratentorial surgery, and ventricular drainage placement compared to the control group. Conversely, the infection group had significantly lower Glasgow Coma Scale (GCS) scores (all p < 0.05). Univariate analysis identified emergency surgery, reoperation, posterior fossa surgery, ventricular drainage placement, ASA > 3, postoperative CSF leakage, ICU admission, stress ulcers, hemoglobin ≤ 110.82 g/L, hyperlipidemia, and high-density lipoprotein (HDL) ≤ 0.89 mmol/L as significant risk factors (p < 0.05). Binary logistic regression revealed CSF leakage (OR: 19.28, 95% CI: 5.24-70.90) and ventricular drainage surgery (OR: 8.18, 95% CI: 2.53-26.39) as independent risk factors.

Postoperative CSF leakage and ventricular drainage are critical risk factors for intracranial infection after craniotomy. Preventive measures, including meticulous watertight dural closure, preservation of the temporal muscle fascia during suturing, subcutaneous tunneling of ventricular drains, and improved postoperative drain management, may decrease infection rates. Timely CSF drainage and targeted antimicrobial therapy are essential for managing established infections.