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Goal: To assess infection rate in a population of children who underwent cranial neurosurgery without hair removal. Methods: Retrospective analysis of clinical records of children undergoing cranial neurosurgery with “shampoo care” during one year. Results: 450 children were included. 5.55% of them had a wound complication, with only two cases of infection (0.4%). Available literature was revised to assess the effectiveness of our protocol. Wound complication and infections rates found in our experience were lower than those reported in patients treated with a standard trichotomy. Conclusion: Cranial neurosurgery without hair removal and “shampoo care” is an effective method to reduce infection rates. This results in a shorter hospital stay, better self-esteem and improved quality of life when the child goes back to family life and school.

Eosinophilic granuloma (EG), Letterer-Siwe disease and Hand-Schuller-Christian disease are collectively called Langherans-cell histiocytosis (LCH). While the latter two are systemic diseases, the former is a localized form of histiocytosis. Solitary EG of the skull are rare lesions characterized by a natural history not well defined yet. In this context, we report a case of a 23-year-old male suffering for a recurrent and progressive right parietal headache. On computed tomography (CT) it was observed an ostelytic lesion which on magnetic resonance imaging (MRI) appeared as an hyperintense soft mass on both T1 and T2 weighted images. The lesion showed a marked and heterogeneous enhancement after gadolinium administration. The surgical excision was complete and the severe headache disappeared. Immunohistochemical analysis of the specimen indicated an eosinophilic granuloma characterized by Ki-67 nuclear antigen expression with a labeling index of 20%. In the pertinent literature we have found two aggressive cases of EG showing the Ki-67 expression with a respectively 6.2% (occipital bone granuloma) and 10% (parietal bone granuloma) labeling index. That high proliferative activity suggests a local Langherans' cell proliferation along with an exuberant inflammatory response and also explains the aggressive clinical course and the rapid expansion of the lesion observed in some rare cases of solitary EG. This is the third case-report of calvarial EG characterized by Ki-67 nuclear antigen expression.