Maskin Luis Patricio, Noya Santiago E, Caffaratti Guido, Echarri Maria Martina, Hlavnicka Alejandro, Cervio Andres
Intensive Care Unit, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina.
Department of Neurosurgery, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Buenos Aires, Argentina.
J Neurol Surg B Skull Base. 2024 May 7;86(2):180-184. doi: 10.1055/a-2298-0898. eCollection 2025 Apr.
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. 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). Incidence of meningitis following EEA surgery with lumbar catheter. 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; < 0.004). There was no statistical difference in the reported incidence of meningitis when CSF leak was present. 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.
鼻内镜鼻内入路（EEA）手术由于直接通过鼻咽黏膜进入，本质上存在污染。报道的EEA手术术后脑膜炎发生率在0.7%至10%之间。EEA手术中使用腰大池引流管来预防脑脊液（CSF）漏，但使用腰大池引流管会增加感染率。本研究调查了基于腰大池引流管（LC）使用情况的术后脑膜炎发生率是否存在差异。
我们对2016年1月至2023年3月在单一机构（儿童神经疾病防治基金会）接受EEA手术的连续患者进行了回顾性研究。
EEA手术联合腰大池引流管术后脑膜炎的发生率。
共纳入72例患者，中位年龄为44岁，53%为女性。最常进行的手术是颅咽管瘤手术，占46%（26例患者）。28例患者使用了腰大池引流管。72例患者中有11例（15.2%）被诊断为脑膜炎，腰大池引流管组（10例患者）的发生率更高。存在腰大池引流管时发生脑膜炎的比值比为23.38（95%置信区间，2.77 - 123.78；P < 0.004）。当存在脑脊液漏时，报道的脑膜炎发生率无统计学差异。
本研究表明，使用腰大池引流管时，EEA手术后脑膜炎的发生率极高（36%）。在我们的队列中，脑膜炎的发生率与脑脊液漏无显著相关性。
