Question about titanium plates in head after craniotomy

Hi @cscmaryann, I'm tagging a few members who have also had a craniotomy like @jhbl @fiddlinchuck @fiddlinchuck @dbprof @craniotomy @lynda1992 @mockinbrd who may have some input to your question.

This is frustrating that you're getting different advice from your specialists. Did they locate any infection? What did you decide to do?

Hello to cscmaryann,
Five years ago I had a craniotomy to correct arteriovenous malformation.
I developed scalp problems that ultimately required me to return to Mayo’s for reconstruction surgery four years later. One non-Mayo M.D. had me put ointment on my scalp. Then my scalp came off exposing one of the four plates keeping my skull closed. That was more than freaky. So, I was lucky to get back to Mayo’s for plastic surgery and neurosurgeon (Dr. Lanzino) to take care of the problem. They took that plate out as it was exposed. My perspective is: the scalp is a thin skin that deserves respect. I was lucky it could have ended differently. I hope this helps in some small way. I like Mayo’s very very much but I keep in mind no guarantees come with medicine. If you have questions, let me know. Peggy

Peggy,
Yikes. Your adventure does sound pretty freaky.
Since no one has been able to pin down source of my sometimes severe headaches, since the 2nd "wash/repair" surgery has healed over, since there is no leakage of wound, no fever, no blood tests revealing infection, advice is to wait and see how continued healing goes. I'm going ahead with proton therapy for second meningioma as I don't want to go through another crainiotomy, and it's not advised to do so because if there is indeed some lingering infection, it would infect the new crainiotomy. Have been advised that if for some reason wound area starts leaking, becoming red, if I have fever or show other signs of infection, I could be put on antibiotics until end of six week proton therapy sessions = then deal with another surgery to open wound area and see what's going on. No need for another surgery at the moment, is advice given to me today from infectious disease dept at Mayo.

No definitive answer as to whether there is lingering infection, or cause of headaches, but infectious disease dr believes it's wise to take a wait and see position, go ahead with six weeks of proton therapy for second meningioma (really don't want to go through another crainiotomy), and, if symptoms of infection do appear, treat with antibiotics until PT is over, then deal with infection and possible surgery then. Thank you for your comments, Colleen.

On Jan 18 had outpatient surgery to remove 3 small plates and screws, debride area of necrotic tissue and remove bone chip and flakes of bone, all result of Aug 1 craniotomy, or Oct 5 "washout" surgery to treat oozing infection of wound. It had been over 5 months since plates were put in, so it was decided by both local neurosurgeon and plastic surgeon who did this last surgery that the timing was ok. In post-op appt Jan 24 was told there is "scant infection" and I will be seeing an infectious disease dr as soon as appt can be set up. Plastic surgeon also was not 100% happy with healing of the skull where plates/screws had been and can't say whether or not the area(s) will continue to heal together. I believe the infection has been there since Aug 1 craniotomy. Hoping for resolution to "scant infection." Mayo plastic surgeon had advised me it's possible I could be on antibiotics for life, so am hoping that's not the case, but will see what infectious disease dr says. In my recent reading on craniotomy, it is imperative that great care is taken prior and during surgery, for infections can occur.

I'm 3 months post-op for a sphenoid wing meningioma. Thank you for posting as this is new information to me, that being the infection issue. My neurosurgeon never brought up this possibility during my pre-surgery consultation nor during my 3 week post-op visit.

I believe it is imperative for surgeons to explain exactly what the procedure and risks are, but some may be unwilling to do that for fear of upsetting patient. Most would probably go through with the surgery anyway. It's hard to imagine how sterile an operating room must be. There are so many factors/people/equipment/clothing issues involved. Life happens. That's how I see it. I believe in prayer and good doctors, in the end.

Came across this thread and want to add to it as I had a titanium plate extrude 2 decades after craniotomy for meningioma. I believe patients should be forewarned this can happen at any time even after a small cut to scalp which is not that thick. My cut was misdiagnosed for 1.5 years starting with dermatologist despite giving my complete history of hardware & radiation at that spot. Eventually resulted in infection & surgery. Like mockinbrd above, at one point after advised to put cream on it, the crust started falling off in chunks to expose the plate and open hole to skull. Missed by dermatology, PCP, neurosurgeon, therefore further need for education that this can happen both for Drs & patients. Patients should get copy of CT scan or at least be informed where the hardware pieces are located. I wish to see this is not brushed off as a rare freakish event as there are many examples on the net.

how about seeing an infectious disease specialist and asking the neurosurgeon for a recommendation? so sorry you are going through this

Hi Maryann,
I join Mayo Connect in early May '24 and came across your post from late '23.

I too am a menigioma survivior/thriver and had difficulty with my titanium plate after a crainiotomy and crainoplasty.

While I did not encounter an infection, I had complications that my neurosurgical team could not explain.

Using my own research skulls and assisted by some close colleagues, there is supportive research that explicitly state that titanium used in "moist" areas of the body (ex. a brain cavity) can result in high sensitivity reactions or infections.

My skin in the area turned severa
l shades darker than my complexion. Had to result to having a treatment from a Mohs trained Surgical Dermatologist ( one who specializes in skin cancer surgery and treatments). She was able to treat the area successfully without a surgical intervention.

The research on titanium usage in 'moist areas' leading to complication was correlated to when one gets dental implants (moist area like the mouth) where the implants are placed in one's mandible, which is bone, like the skull.

Like you, my surgical team seemed clueless about such a probability of this causation, yet they didnot question the merits of the research or my posture that without any answers from them, I sought, found and remedied my own post surgical problem.