The optimal management of cranioplasty infections remains a matter of debate. Most authors have suggested that the infected bone/implant removal is mandatory, combined with prolonged antibiotic therapy before reconstruction. However, failures can occur, even with 12–18-month intervals between the surgeries. Longer wait times before cranial reconstruction increase the risks of socioeconomic burdens and further complications, as observed in decompressed patients hosting shunts. In our department, we treated 48 cranioplasty infections over a period of 8 years, divided into two groups. For Group A (n = 26), the treatment consisted of cranioplasty removal and debridement, followed by a delayed reconstruction. Group B (n = 22) received 2 weeks of broad-spectrum antibiotics, followed by an “aggressive” field debridement and immediate cranioplasty. All patients received a minimum of 8 weeks of post-operative antibiotic therapy and were scheduled for clinic-radiological follow-ups for at least 36 months. Significant differences were observed between Groups A and B with respect to the number of failures (respectively 7 versus 1), the global operative time (significantly longer for Group B), germ identification (respectively 7 versus 13), and the overall length of hospital stay (on average, 61.04 days in Group A versus 47.41 days in Group B). Three shunted patients in Group A developed sinking flap syndrome. Shunt resetting allowed symptom control until cranioplasty in one subject, whereas two did not improve, even after reconstruction. In selected patients, an aggressive field debridement, followed by the immediate replacement of an infected cranioplasty, may represent a safe and valuable option.

颅骨成形术感染的最佳治疗仍然是一个有争议的问题。大多数作者建议必须将受感染的骨/植入物去除，并在重建前延长抗生素治疗时间。但是，即使两次手术之间的间隔时间为12-18个月，也会发生故障。如在接受分流的减压患者中观察到的那样，在颅骨重建之前等待时间较长会增加社会经济负担和进一步并发症的风险。在我们的科室，​​我们在8年中治疗了48例颅骨成形术感染，分为两组。对于A组（n  = 26），治疗包括颅骨成形术去除和清创术，然后延迟重建。B组（n  = 22）接受了2周的广谱抗生素治疗，随后接受了“好斗的现场清创术和即刻颅骨成形术。所有患者均接受了至少8周的术后抗生素治疗，并计划接受临床放射学随访至少36个月。观察到A组和B组之间在失败次数（分别为7对1），总手术时间（对于B组明显更长），细菌鉴定（分别为7对13）和医院总长方面存在显着差异。停留时间（A组平均61.04天，B组47.41天）。A组中的三名分流患者发展为下沉皮瓣综合征。分流复位可以控制症状，直到一名患者进行颅骨成形术为止，而即使重建后，两名患者也没有改善。在选定的患者中，进行野性清创术，