A consultant anesthetist should see all craniotomy patients preoperatively. Elderly patients (>70 years) and patients on multiple medications should routinely also seen by consultant internist, to optimize the general medical condition and medications. At our institution, a second-generation cephalosporin is administered intravenously at initiation of surgery and continued every 90 min until the case is completed or the maximum daily dose of 8 g is reached. For long cases, erythromycin or a third-generation cephalosporin is started after the maximum daily dose of a second-generation cephalosporin is reached and continued until completion of the case. Antibiotics are not routinely used in the postoperative phase.

First-time craniotomies with primary resection were performed in 2,073 cases, 483 cases were reoperations with repeated resection, and 74 cases were open biopsies. Thus, the incidence of first-time craniotomy for a brain tumor was 12.8/100,000 inhabitants per year and for a repeat resection 3.0/100,000 inhabitants per year.

A total of 39 patients (1.5 %) were reoperated for deep postoperative infection (Table 20.2). Of these infections, 23 (59.0 %) were extradural (ED), 6 (15.4 %) intradural (ID), and 10 (25.6 %) were both intra- and extradural.