Abstract
Objectives
Anterior skull base surgery is commonly used for the surgical treatment of a variety
of skull base lesions. One uncommon, but serious postoperative complication of this
procedure is meningitis. Prophylactic antibiotics are widely used but with considerable
variability in duration and regimes due to lack of guidelines. This systematic review
was carried out to determine the benefit of prophylactic antibiotics in preventing
meningitis in patients undergoing endonasal anterior skull base surgery.
Methods
The review was undertaken according to Preferred Reporting Items for Systematic reviews
and Meta-Analyses guidelines. Online searches including PubMed, MEDLINE, EMBASE, Cochrane,
and gray literature were performed up to May 2, 2024. Articles reporting on patients
undergoing endoscopic anterior skull base surgery, the use or not of prophylactic
antibiotics, and follow-up outcomes were included for selection. Data extracted included
demographics, pathology, prophylactic antibiotic duration/type, nasal pack use, cerebrospinal
fluid (CSF) leaks, meningitis rates, sinusitis rates, and other complications.
Results
A total of 32 studies were included in this systematic review, totaling 26,477 patients
published between 1981 and 2023. The overall rate of developing meningitis with any
duration of use of antibiotics was 2%. Patients receiving intraoperative antibiotics
alone had a higher rate of subsequent meningitis (3%) compared with patients receiving
a postoperative course of 24 hours or a longer course (1%). Patients who had an intraoperative
or postoperative CSF leak had a higher rate of meningitis (10%) than those without
(0%).
Conclusion
This review indicates that postoperative antibiotic course may be more effective in
preventing meningitis. Patients who develop a CSF leak have a higher risk of developing
meningitis.
Keywords
meningitis - prophylactic antibiotics - skull base surgery - transsphenoidal surgery
- CSF leak
