Postoperative Neurosurgical Wound Complications: Review Article

Abstract

Wound complications following neurosurgical operations are not localized technical failures but represent a profound clinical and economic challenge to healthcare systems globally. An intricate and successful intradural procedure can be completely undermined by a subsequent wound breakdown or infection. These complications are a primary driver of significant patient morbidity, initiating a cascade of negative outcomes that includes prolonged hospital stays, the need for repeated surgical interventions, and high rates of unplanned hospital readmission. Surgical site infections (SSIs) in particular are consistently identified as one of the most common reasons for readmission following neurosurgical procedures.   This review will focus on the most common and consequential neurosurgical wound complications: Surgical Site Infection (SSI), Cerebrospinal Fluid (CSF) Leak, Wound Dehiscence, and Postoperative Hematoma/Seroma. It is crucial to understand that these pathologies are not isolated events. The literature strongly supports viewing them as an interconnected causal cascade. A seemingly minor complication, such as a CSF leak, can create a wet wound environment, an "ideal host for organisms", which then leads to a 15-fold increase in the risk of SSI. The resulting infection can, in turn, impair tissue healing, leading to wound dehiscence. This review has established that the CSF leak is the lynchpin complication, acting as the primary gateway to SSI. Consequently, dural closure technology is a critical research frontier. Future Perspectives: The "holy grail" of this research area would be a multifunctional sealant. The future of development may lie in materials that are not just adhesive but also possess antimicrobial and analgesic properties. Such an "active sealant" would solve two problems simultaneously: providing a mechanical barrier to CSF leakage while also delivering chemical prophylaxis directly to the high-risk closure site.