Self-Trephination Resulting in Exposed Brain Matter and Cerebral Abscess in a Schizophrenic Patient With Delusions.

A 56-year-old woman with schizophrenia presented with persistent foreign body delusions, who chronically excavated her scalp and skull, resulting in a large cranial wound with granulation tissue, purulent discharge, and pneumocephalus. CT scans revealed bilateral subdural hematomas (SDH), polymicrobial osteomyelitis, and a brain abscess causing cerebral edema. The neurosurgical intervention involved cranial washout, debridement, and scalp reconstruction via rotational flap closure, followed by broad-spectrum antibiotics tailored to culture results.