The Risk of Meningitis Following Expanded Endoscopic Endonasal Skull Base Surgery: A Systematic Review

Lai, Leon T.
Trooboff, Spencer
Morgan, Michael K.
Harvey, Richard J.

¹Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
²Applied Medical Research Centre, University of New South Wales, Sydney, Australia
³Ohio State University College of Medicine, Columbus, United States

Address for correspondence Leon Tat Lai, MBBS, Australian School of Advanced Medicine, 2 Technology Place, Macquarie University, NSW 2109, Australia (e-mail: [email protected]).

received January 3, 2013

accepted after revision June 15, 2013

published online September 10, 2013

Journal of Neurological Surgery Part B : Skull Base 75(1):p 18-26, February 2014. | DOI: 10.1055/s-0033-1353365

Objective

To examine the risk of postoperative meningitis following expanded endoscopic endonasal skull base (EESB) surgery.

Setting

A systematic analysis of publications identified through searches of the electronic databases from Embase (1980-July 17, 2012), Medline (1950-July 17, 2012), and references of review articles.

Main Outcome Measures

Incidence of meningitis following EESB surgery.

Results

A total of 2,444 manuscripts were selected initially, and full-text analysis produced 67 studies with extractable data. Fifty-two contained data regarding the frequency of postoperative meningitis. The overall risk of postoperative meningitis following EESB surgery was 1.8% (36 of 2,005). For those reporting a cerebrospinal fluid (CSF) leak, meningitis occurred in 13.0% (35 of 269). For those not reporting a CSF leak, meningitis occurred in 0.1% (1 of 1,736). The odds ratio for the development of meningitis in the presence of a postoperative CSF leak was 91.99 (95% confidence interval, 11.72-721.88; p < 0.01). There was no difference in reported incidence of meningitis or CSF leak between anterior and posterior cranial fossa surgery. There was one reported case of meningitis-related mortality following EESB surgery.

Conclusion

The evidence in skull base surgery is limited. This study demonstrates a low incidence of meningitis (1.8%) following EESB procedures. The incidence of meningitis from EESB surgery without an associated CSF leak is uncommon.