Short- and Long-Term Risk of Meningitis Following Pediatric Endoscopic Transsphenoidal Surgery

To determine both the short- and long-term risks of meningitis in children and adolescents undergoing transsphenoidal skull base surgery.

Retrospective analysis of the Pediatric Health Information System (PHIS) database over a 10-year period.

The PHIS database was reviewed to identify individuals ≤ 18 years of age who underwent endoscopic transsphenoidal surgery from 2012 to 2022. Data regarding patient demographics, length of stay, and need for revision surgery was recorded. To assess both the short- and long-term risk of postoperative meningitis, a PHIS query was performed for all readmissions of the initial cohort between 2012 and 2024. Any readmission related to meningitis was reviewed and analyzed. Subgroup analysis was performed based on patient age at initial surgery, gender, geographic region, insurance carrier, and need for revision surgery.

Total of 476 patients (501 cases) with a mean age of 12.8 years (SD: 4.0 years) met inclusion criteria. Twenty-four patients (5.0%) developed meningitis, 13 (2.7%) during their initial hospitalization and 11 (2.3%) following discharge, the latter within a range of 0.4-38.9 months (mean 8.1 months). Length of stay was significantly higher in patients who developed meningitis. Younger age at the time of surgery was the only risk factor identified.

The short-term risk of postoperative meningitis following pediatric transsphenoidal skull base surgery is similar to that of the adult population. The long-term risk is also low, with most cases occurring within 1 year of discharge. Patients < 12 years of age have the highest risk and warrant consideration of prophylactic antibiotics.