The necessity for scalp hair removal in skull base surgery

The routine of hair shaving before surgery has been a common procedure in craniofacial and skull base surgery. Hair shaving may cause an additional psychological stress to the patient, slowing the restoration of a normal self-image. We have performed skull base operations without hair removal in 169 patients (ages from 3 to 81 years). The objective of this study was to evaluate the surgical wound infection rate of this group of unshaved patients. The surgical procedures included skull base operations due to: tumors, trauma, fungal infections, brain abscess, cerebrospinal fluid leaks, vascular disorders, and reconstruction procedures. The operative region was scrubbed before surgery with chlorhexidine and water. Perioperative antibiotics were administered using a combination of Cefuroxime and/or Metronidazole. The overall surgical wound infection rate was 1.1% (2/169). In 1 patient the wound infection was associated with perioperative radiation therapy. The infection rate found in this retrospective study is similar to that found in cranial and skull base operations conducted with hair shaving. It is concluded that skull base surgery without hair removal is safe and is not associated with increased risk of infections. Unshaving of cranial hair is desired by most of the patients, and allows rapid rehabilitation and reinstatement of normal daily life.