Impact of the Lumbar Catheter on the Incidence of Postsurgical Meningitis in the Endoscopic Endonasal Approach

Abstract

Objectives Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is between 0.7 and 10%. Lumbar catheters are used in EEA surgeries to prevent cerebrospinal fluid (CSF) fistulae, but their use is associated with increased infection rates. This study investigated whether there is a difference in rates of postoperative meningitis based on lumbar catheter (LC) utilization.

Methods We performed a retrospective review of consecutive patients who underwent EEA surgeries between January 2016 and March 2023 at a single institution (Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia).

Main Outcome Incidence of meningitis following EEA surgery with lumbar catheter.

Results Seventy-two patients were enrolled, median age was 44 years, and 53% were female. The most frequent surgery performed was craniopharyngioma 46% (26 patients). A LC was used in 28 patients. Meningitis was diagnosed in 11 of 72 patients (15.2%), being higher in the LC group (10 patients). The odds ratio for the development of meningitis in the presence of an LC was 23.38 (95% confidence interval, 2.77–123.78; p < 0.004). There was no statistical difference in the reported incidence of meningitis when CSF leak was present.

Conclusion This study demonstrates an extremely high incidence of meningitis (36%) following EEA procedures when an LC is used. The incidence of meningitis was not significantly associated with CSF leak in our cohort.

Keywords

CSF leak - expanded EEA - lumbar catheter - meningitis

Publication History

Received: 28 November 2023

Accepted: 28 March 2024

Accepted Manuscript online:
02 April 2024

Article published online:
07 May 2024

• References

• 1 Paluzzi A, Gardner P, Fernandez-Miranda JC, Snyderman C. The expanding role of endoscopic skull base surgery. Br J Neurosurg 2012; 26 (05) 649-661
• 2 Hadad G, Bassagasteguy L, Carrau RL. et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116 (10) 1882-1886
• 3 Zwagerman NT, Wang EW, Shin SS. et al. Does lumbar drainage reduce postoperative cerebrospinal fluid leak after endoscopic endonasal skull base surgery? A prospective, randomized controlled trial. J Neurosurg 2018; 131 (04) 1-7
• 4 Ackerman PD, Spencer DA, Prabhu VC. The efficacy and safety of preoperative lumbar drain placement in anterior skull base surgery. J Neurol Surg Rep 2013; 74 (01) 1-9
• 5 Açikbaş SC, Akyüz M, Kazan S, Tuncer R. Complications of closed continuous lumbar drainage of cerebrospinal fluid. Acta Neurochir (Wien) 2002; 144 (05) 475-480
• 6 Li G, Zhang Y, Zhao J, Han Z, Zhu X, Hou K. Some cool considerations of external lumbar drainage during its widespread application in neurosurgical practice: a long way to go. Chin Neurosurg J 2016 ;2(1)
• 7 Mayhall CG, Archer NH, Lamb VA. et al. Ventriculostomy-related infections. A prospective epidemiologic study. N Engl J Med 1984; 310 (09) 553-559
• 8 Tunkel AR, Hasbun R, Bhimraj A. et al. 2017 Infectious Diseases Society of America's Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis 2017; 64 (06) e34-e65
• 9 Maskin LP, Capparelli F, Mora A. et al. Cerebrospinal fluid lactate in post-neurosurgical bacterial meningitis diagnosis. Clin Neurol Neurosurg 2013; 115 (09) 1820-1825
• 10 Ivan ME, Iorgulescu JB, El-Sayed I. et al. Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery. J Clin Neurosci 2015; 22 (01) 48-54
• 11 Caggiano C, Penn DL, Laws Jr ER. The role of the lumbar drain in endoscopic endonasal skull base surgery: a retrospective analysis of 811 cases. World Neurosurg 2018; 117: e575-e579
• 12 Guo X, Zhu Y, Hong Y. Efficacy and safety of intraoperative lumbar drain in endoscopic skull base tumor resection: a meta-analysis. Front Oncol 2020; 10: 606
• 13 Qiao N, Li C, Liu F. et al. Risk factors for cerebrospinal fluid leak after extended endoscopic endonasal surgery for adult patients with craniopharyngiomas: a multivariate analysis of 364 cases. J Neurosurg 2023; 140 (01) 47-58
• 14 Kono Y, Prevedello DM, Snyderman CH. et al. One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses. Infect Control Hosp Epidemiol 2011; 32 (01) 77-83
• 15 Lai LT, Trooboff S, Morgan MK, Harvey RJ. The risk of meningitis following expanded endoscopic endonasal skull base surgery: a systematic review. J Neurol Surg B Skull Base 2014; 75 (01) 18-26
• 16 Lee SJ, Cohen J, Chan J, Walgama E, Wu A, Mamelak AN. Infectious complications of expanded endoscopic transsphenoidal surgery: a retrospective cohort analysis of 100 cases. J Neurol Surg B Skull Base 2020; 81 (05) 497-504
• 17 Liang H, Zhang L, Gao A. et al. Risk factors for infections related to lumbar drainage in spontaneous subarachnoid hemorrhage. Neurocrit Care 2016; 25 (02) 243-249
• 18 Scheithauer S, Bürgel U, Bickenbach J. et al. External ventricular and lumbar drainage-associated meningoventriculitis: prospective analysis of time-dependent infection rates and risk factor analysis. Infection 2010; 38 (03) 205-209
• 19 Schade RP, Schinkel J, Visser LG, Van Dijk JM, Voormolen JH, Kuijper EJ. Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters. J Neurosurg 2005; 102 (02) 229-234
• 20 Kryzanski JT, Annino DJ, Gopal H, Heilman CB. Low complication rates of cranial and craniofacial approaches to midline anterior skull base lesions. Skull Base 2008; 18 (04) 229-241