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Risk factors for meningitis after transsphenoidal surgery
M O van Aken1, S de Marie, A J van der Lely
1Department of Internal Medicine, University Hospital Rotterdam, The Netherlands.
Abstract:
To evaluate possible risk factors for meningitis, we retrospectively reviewed 228 transsphenoidal operations (in which a standard regimen of amoxicillin prophylaxis was used) for sellar pathology. The incidence of meningitis was 3.1% (seven of 228 cases). Cultures of preoperative specimens from the anterior nasal vestibule in three of seven patients yielded Staphylococcus aureus, but none of these patients developed S. aureus meningitis. Two of three patients with significant preoperative paranasal sinus abnormalities developed meningitis compared with only five of 225 patients without significant paranasal sinus abnormalities (P < .005). Three of 22 patients with intraoperative cerebrospinal fluid (CSF) leakage developed meningitis compared with four of 206 patients without intraoperative CSF leakage (P < .05). Six of seven patients with postoperative CSF rhinorrhea and only one of 221 patients without postoperative CSF rhinorrhea developed meningitis (P < .00001). In conclusion, postoperative CSF leakage is an important risk factor for meningitis after transsphenoidal surgery. Cultures of preoperative specimens from the anterior nasal vestibule did not have any predictive value in our study.
Insights
Postoperative cerebrospinal fluid (CSF) leakage is a significant risk factor for meningitis after transsphenoidal surgery. Preoperative nasal cultures did not predict meningitis risk in this study.
Area of Science:
- Neurosurgery
- Infectious Disease Epidemiology
Background:
- Transsphenoidal surgery is a common procedure for sellar pathology.
- Meningitis is a potential complication following such surgeries.
- Antibiotic prophylaxis is standard practice.
Purpose of the Study:
- To identify risk factors for meningitis after transsphenoidal operations.
- To evaluate the predictive value of preoperative nasal cultures.
Main Methods:
- Retrospective review of 228 transsphenoidal operations.
- Analysis of patient data including preoperative sinus abnormalities, intraoperative and postoperative cerebrospinal fluid (CSF) leakage, and meningitis incidence.
- Cultures of preoperative nasal vestibule specimens were analyzed.
Main Results:
- The overall incidence of meningitis was 3.1%.
- Significant preoperative paranasal sinus abnormalities (P < .005) and postoperative CSF rhinorrhea (P < .00001) were associated with increased meningitis risk.
- Intraoperative CSF leakage showed a trend towards increased risk (P < .05).
- Preoperative nasal cultures for Staphylococcus aureus did not correlate with meningitis development.
Conclusions:
- Postoperative CSF leakage is a critical risk factor for meningitis post-transsphenoidal surgery.
- Preoperative nasal vestibule cultures lack predictive value for meningitis in this context.