Facteurs de risque, diagnostic et prise en charge de l'ostéite du volet crânien après craniectomie

The bone flap osteomyelitis following craniectomy (BPOc) is a postoperative bone infection. Few data are available about its epidemiology and risk factors. In addition, the medico-surgical management of BPOc is not consensual. The bone forming the cranial flap is usually fixed with metal plates or other fastening systems, so that the BPOc must be considered as an implant-associated infection. There are no clear criteria for the diagnosis of BPOc. The infection may be acute, with suppuration in contact with the cranial flap and empyema, or be in a chronic form of bone infection with skin erosion exposing the bone without fever. For the microbiological diagnosis, it seems important to have bacterial cultures of all intracranial suppuration; (ii) of the cranial flap; and (iii) of the edges of the craniectomy. Support of BPOc is complex and multidisciplinary approach is required in reference centers. A 2-stage strategy (removing the bone flap and then, months later, after completion of the antimicrobial therapy, reconstruction and cranioplasty with ceramic custom made implant) is often necessary. Antibiotics should always cover the bacteria considered to be involved in BPOc, as recommended by the Société de pathologies infectieuses de langue française. The duration of antibiotic treatment will depend on the acute or chronic nature of the infection, and on the quality of the surgery.