Although surgical site infection after craniotomy (SSI-CRAN) is a serious complication, risk factors for its development have not been well defined. We aim to identify the risk factors for developing SSI-CRAN in a large prospective cohort of adult patients undergoing craniotomy. A series of consecutive patients who underwent craniotomy at a university hospital from January 2013 to December 2015 were prospectively assessed. Demographic, epidemiological, surgical, clinical and microbiological data were collected. Patients were followed up in an active post-discharge surveillance programm e for up to one year after surgery. Multivariate analysis was carried out to identify independent risk factors for SSI-CRAN. Among the 595 patients who underwent craniotomy, 91 (15.3%) episodes of SSI-CRAN were recorded, 67 (73.6%) of which were organ/space. Baseline demographic characteristics were similar among patients who developed SSI-CRAN and those who did not. The most frequent causative Gram-positive organisms were Cutibacterium acnes (23.1%) and Staphylococcus epidermidis (23.1%), whereas Enterobacter cloacae (12.1%) was the most commonly isolated Gram-negative agent. In the univariate analysis the factors associated with SSI-CRAN were ASA score > 2 (48.4% vs. 35.5% in SSI-CRAN and no SSI-CRAN respectively, p = 0.025), extrinsic tumour (28.6% vs. 19.2%, p = 0.05), and re-intervention (4.4% vs. 1.4%, p = < 0.001). In the multivariate analysis, ASA score > 2 (AOR: 2.26, 95% CI: 1.32–3.87; p = .003) and re-intervention (OR: 8.93, 95% CI: 5.33–14.96; p < 0.001) were the only factors independently associated with SSI-CRAN. The risk factors and causative agents of SSI-CRAN identified in this study should be considered in the design of preventive strategies aimed to reduce the incidence of this serious complication.

Background: Surgical site infections after craniotomy (SSI-CRAN) significantly impact patient outcomes and healthcare costs by increasing length of stay and readmission and reoperation rates. However, to our knowledge, no study has yet analysed the economic impact of a surgical care bundle for preventing SSI-CRAN. The aim is to analyse the hospital cost saving after implementation of a care bundle for the prevention of SSI-CRAN. Methods: A retrospective cost-analysis was performed, considering two periods: pre-care bundle (2013–2015) and care bundle (2016–2017). A bottom-up approach was used to calculate the costs associated with infection in patients who developed a SSI-CRAN in comparison to those who did not, in both periods and on a patient-by-patient basis. The derived cost of SSI-CRAN was calculated considering: (1) cost of the antibiotic treatment, (2) cost of length of stay in the neurosurgery ward within the 1-year follow up period, (3) cost of the re-intervention, and (4) cost of the implant for cranial reconstruction, when necessary. Results: A total of 595 patients were included in the pre-care bundle period and 422 in the care bundle period. Mean cost of a craniotomy procedure was approximately €8000, rising to €24,000 in the case of SSI-CRAN. Mean yearly hospital costs fell by €502,857 in the care bundle period (€714,886 vs. €212,029). Extra costs between periods were mainly due to increased length of hospital stay (€573,555.3 vs. €183,958.9; difference: €389,596.4), followed by the cost of implant for cranial reconstruction (€69,803.4 vs. €9,936; difference: €59,867.4). Overall, implementation of the care bundle saved the hospital €500,844.3/year. Conclusion: The implementation of a care bundle for SSI-CRAN had a significant economic impact. Hospitals should consider the deployment of this multimodal preventive strategy to reduce their SSI-CRAN rates, and also their costs.

In this review, we evaluate the knowledge gained so far about the neural bases of multilingual language processing obtained mainly through imaging and electrical stimulation mapping (ESM). We attempt to answer some key questions about multilingualism in the light of recent literature evidence, such as the degree of anatomical–functional integration of two or more languages in a multilingual brain, how the age of L2-acquisition affects language organization in the human brain, or how the brain controls more than one language. Finally, we highlight the future trends in multilingual language mapping.

Background and Objectives: The proximity of insular gliomas to eloquent brain structures and complex vascular anatomy makes preservation of neurological function during resection challenging. This study investigates postoperative motor deficits after insular glioma resection and their association with intraoperative neuromonitoring and ischemia. Methods: In total, 64 patients who underwent insular glioma resection between 2018 and 2025 were included. Extent of resection (EOR), intraoperative MEP changes, subcortical stimulation thresholds, postoperative ischemic lesions and motor outcomes at 3 months were evaluated. Results: Median EOR was 93.4% (IQR 87.4–100%), and median residual tumor volume was 4.5 cm³ (IQR 0–8.1). MEP monitoring was performed in 56 patients (87.5%); deterioration occurred in 3 (5.4%), all of whom developed persistent deficits. MEP deterioration showed 60% sensitivity (95% CI 14.7–94.7%), 100% specificity (95% CI 93.0–100%), 100% positive predictive value (95% CI 29.2–100%), and 96.2% negative predictive value (95% CI 87.0–99.5%). The positive predictive value should be interpreted cautiously given the small number of events. Subcortical responses were elicited in 48 patients (85.7%). Tumors involving Berger–Sanai zones II and/or III had lower subcortical stimulation thresholds than tumors sparing both regions (median 4 vs. 8.5 mA; p = 0.012), although thresholds were not associated with motor deficits or ischemia. Postoperative ischemic lesions occurred in 20 patients (31.3%). Persistent motor deficits occurred in 6 patients (9.4%), all with associated ischemic lesions. Conclusions: Postoperative motor deficits were associated with ischemic lesions. MEP deterioration showed high specificity and positive predictive value, but limited sensitivity. Subcortical stimulation provided functional information about corticospinal tract proximity. These findings highlight the importance of preserving vascular supply to motor pathways during insular glioma surgery.