Department of Otorhinolaryngology, Turku University Hospital and University of Turku, Turku, Finland.
Department of Infectious Diseases, Turku University Hospital and University of Turku, Turku, Finland.
Acta Neurochir (Wien). 2024 Jul 18;166(1):300. doi: 10.1007/s00701-024-06193-w.
Post-neurosurgical meningitis (PNM) constitutes a grave complication associated with substantial morbidity and mortality. This study aimed to determine the risk factors predisposing patients to PNM following surgery for low- and high-grade gliomas.
We conducted a retrospective analysis encompassing all patients who underwent glioma surgery involving craniotomy at Turku University Hospital, Turku, Finland, between 2011 and 2018. Inclusion criteria for PNM were defined as follows: (1) Positive cerebrospinal fluid (CSF) culture, (2) CSF leukocyte count ≥ 250 × 10/L with granulocyte percentage ≥ 50%, or (3) CSF lactate concentration ≥ 4 mmol/L, detected after glioma surgery. Glioma grades 3-4 were classified as high-grade (n = 261), while grades 1-2 were designated as low-grade (n = 84).
Among the 345 patients included in this study, PNM developed in 7% (n = 25) of cases. The median time interval between glioma surgery and diagnosis of PNM was 12 days. Positive CSF cultures were observed in 7 (28%) PNM cases, with identified pathogens encompassing Staphylococcus epidermidis (3), Staphylococcus aureus (2), Enterobacter cloacae (1), and Pseudomonas aeruginosa (1). The PNM group exhibited a higher incidence of reoperations (52% vs. 18%, p < 0.001) and revision surgery (40% vs. 6%, p < 0.001) in comparison to patients without PNM. Multivariable analysis revealed that reoperation (OR 2.63, 95% CI 1.04-6.67) and revision surgery (OR 7.08, 95% CI 2.55-19.70) were significantly associated with PNM, while glioma grade (high-grade vs. low-grade glioma, OR 0.81, 95% CI 0.30-2.22) showed no significant association.
The PNM rate following glioma surgery was 7%. Patients requiring reoperation and revision surgery were at elevated risk for PNM. Glioma grade did not exhibit a direct link with PNM; however, the presence of low-grade gliomas may indirectly heighten the PNM risk through an increased likelihood of future reoperations. These findings underscore the importance of meticulous post-operative care and infection prevention measures in glioma surgeries.
神经外科术后脑膜炎（PNM）是一种严重的并发症，与较高的发病率和死亡率相关。本研究旨在确定导致低级别和高级别胶质瘤患者术后发生 PNM 的风险因素。
我们对 2011 年至 2018 年期间在芬兰图尔库大学医院接受开颅手术治疗胶质瘤的所有患者进行了回顾性分析。PNM 的纳入标准定义为：（1）脑脊液（CSF）培养阳性，（2）CSF 白细胞计数≥250×10/L，粒细胞百分比≥50%，或（3）CSF 乳酸浓度≥4mmol/L，在胶质瘤手术后检测到。胶质瘤分级 3-4 级为高级别（n=261），1-2 级为低级别（n=84）。
本研究共纳入 345 例患者，7%（n=25）发生 PNM。PNM 诊断与胶质瘤手术的中位时间间隔为 12 天。7 例（28%）PNM 患者的 CSF 培养阳性，鉴定的病原体包括表皮葡萄球菌（3）、金黄色葡萄球菌（2）、阴沟肠杆菌（1）和铜绿假单胞菌（1）。与无 PNM 的患者相比，PNM 组的再手术率（52%比 18%，p<0.001）和翻修手术率（40%比 6%，p<0.001）更高。多变量分析显示，再手术（OR 2.63，95%CI 1.04-6.67）和翻修手术（OR 7.08，95%CI 2.55-19.70）与 PNM 显著相关，而胶质瘤分级（高级别与低级别胶质瘤，OR 0.81，95%CI 0.30-2.22）与 PNM 无显著相关性。
胶质瘤手术后 PNM 的发生率为 7%。需要再次手术和翻修手术的患者发生 PNM 的风险增加。胶质瘤分级与 PNM 之间无直接关联；然而，低级别胶质瘤的存在可能通过增加再次手术的可能性间接增加 PNM 的风险。这些发现强调了在胶质瘤手术中进行精细的术后护理和感染预防措施的重要性。
