Meningitis Following Lateral Skull Base Surgery

Abstract

Objective: 1) Determine the clinical course of meningitis in the following lateral skull base surgery. 2) Examine risk factors leading to meningitis following lateral skull base surgery.

Method: Retrospective review of patients undergoing lateral skull base surgery between February 1999 and March 2010. All subjects had culture-proven meningitis in the postoperative period. Medical records were compared with the lateral skull base patients who did not develop meningitis.

Results: Fourteen of 508 patients (2.8%) developed meningitis following lateral skull base surgery. The most common diagnosis was acoustic neuroma in 78.5%. A total of 64.3% of patients had a CSF leak prior to meningitis onset, and 42.9% received a lumbar drain. The mean time to onset of meningitis was 16.1 days. The most common pathogens were staphylococcus, streptococcus, and enterococcus species; each in 14.3% of cases. A total of 10.3% of patients with postoperative CSF leakage and 9.2% with lumbar drains developed meningitis. The odds ratio of developing meningitis in the setting of a postoperative CSF leak is 7.3. There were no meningitis associated mortalities.

Conclusion: Postoperative meningitis was seen in 2.8% of lateral skull base surgeries. As expected a CSF leak and placement of a lumbar subarachnoid drain are significant risk factors for developing meningitis. No mortality was associated with meningitis.