Association between Cerebrospinal Fluid Leak and Meningitis after Skull Base Surgery

Abstract

Postoperative CSF leak significantly increases the risk of meningitis. Most cases of meningitis after skull base operation are probably associated with lumbar drainage infection or from an obscure leak.

Dural Involvement in Skull Base Tumors—Accuracy of Preoperative Radiological Evaluation and Intraoperative Assessment

“…Horowitz et al showed that postoperative CSF leak significantly increases the risk of meningitis. 17 Hence, a decision to breach it intentionally has to be weighed carefully. In our own results, all the leaks occurred only when the dura was breached.…”

Systematic Review of the Effectiveness of Perioperative Prophylactic Antibiotics for Skull Base Surgeries

“…[7][8][9][10][11][12][13][14][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] The most commonly correlated finding was an intra-or postoperative CSF leak, which may result in the development of meningitis through failure of a tight closure of the cranial diaphragm, catheter infection of the lumbar drain, ascending infection from an obscure leak, or ascending infections from the contaminated paranasal sinuses via the skull base defect during or after surgery. 11,14 Lai et al 7 systematically studied the incidence of meningitis after endoscopic endonasal skull base surgery from 1950 to 1980 and reported a rate of 1.8%. This number was strongly correlated with a CSF leak because meningitis occurred in 13% of those who reported a CSF leak (35/269) and only 0.1% without a CSF leak (1/1736).…”

“…Postoperative meningitis is uncommon and seems to be most commonly associated with postoperative cerebrospinal fluid (CSF) leak. [7][8][9][10][11][12][13] This rarity of reported meningitis is thought to be due to the high vascularity of the head and neck, and infrequency of dural disruption during dissection, so the presence of CSF leak may be worth examining as an independent risk factor. However, with advancing techniques and experience, transdural surgery is becoming more commonplace, and, yet, meningitis is still a rare complication.…”

Tetrahedral silicon balloon for endoscopic skull base reconstruction

“…Displacement of the flap may lead to severe complications, such as CSF leak, pneumocephalus, and meningitis, which may require a second operation. 18 Flap migration and reconstruction breakdown may occur for several reasons: 1) the support is not anatomically shaped as in the case of a balloon catheter, leading to unequal pressure vectors over the flap and to its traction; 2) malpositioning of the support that is placed blindly and not under endoscopic guidance; and 3) migration or change in the shape of the support during the early postoperative period, such as in the case of leaking Foley catheters. The TSB precisely addresses these drawbacks of conventional supporting methods.…”