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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.
Summary
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.