Cranial procedures without hair removal

OBJECTIVE: In 1992, Winston published the first large series of patients undergoing cranial neurosurgery without hair removal (Winston KR: Hair and neurosurgery. Neurosurgery 31:320-329, 1992). Prompted by this report, the senior author began a prospective trial in 1992 of cranial neurosurgery without hair removal. METHODS: All patients undergoing elective cranial surgery were offered the opportunity to undergo surgery without hair removal. The protocol advocated by Winston was strictly followed in the first 100 patients but has subsequently been modified. Patients having only cranial procedures have their head prepared for 10 minutes with chlorhexidine and water followed by an isopropyl alcohol rinse. Patients having craniofacial procedures are prepared with iodophor. A single perioperative dose of prophylactic antibiotic is administered. RESULTS: We have performed 346 cranial operations without hair removal. These include craniotomy for tumor, trauma, and aneurysm (n = 115); epilepsy procedures, including depth, subdural strip, and grid electrode placement, lobectomy, and callosotomy (n = 95); functional procedures, including thalamotomy, pallidotomy, capsulotomy, and stereotactic biopsy (n = 84); ventriculoperitoneal shunts (n = 8); brain abscess aspiration or resection (n = 5); and miscellaneous other procedures (n = 10). Twenty-nine patients underwent cranial base procedures in conjunction with an otolaryngologist and had the alternate preparation. There have been no infections and no other complications associated with not removing hair. CONCLUSION: Cranial surgery without hair removal is safe and is not associated with a discernible increased risk of infection. There are simple techniques for keeping hair out of the wound. Patients are highly desirous of keeping their hair and react very positively to this option. We advocate a greater practice of this technique in neurosurgery.