Tang Yue, Xu Hongmiao, Liu Dong, Lin Tingting, Zuo Fujun, Wen Dingli, Liao Yinjuan, Ye Zhennan, Liu Peng, Zhang Jincan
Department of Neurosurgery, The Fourth Hospital of Changsha, Changsha, China.
Department of Critical Care Medicine, The Fourth Hospital of Changsha, Changsha, China.
Front Neurol. 2025 Apr 15;16:1586394. doi: 10.3389/fneur.2025.1586394. eCollection 2025.
Early and accurate diagnosis of central nervous system infections (CNSIs) is crucial for clinical treatment. Cerebrospinal fluid (CSF) analysis is considered the gold standard for diagnosis, and the sensitivity of its results directly affects treatment decisions. However, due to physiological differences in CSF composition between the ventricles and the lumbar space, the choice of sampling site may lead to diagnostic discrepancies, including false negatives. This study aims to compare the diagnostic sensitivity of CSF samples obtained via external ventricular drainage (EVD) and lumbar puncture (LP) in patients with CNSIs following craniotomy.
This study prospectively collected data from patients who underwent craniotomy and had EVD placement between January 2024 and December 2024. For patients suspected of CNSIs, CSF samples were simultaneously collected via LP and EVD, and the differences in cell counts and biochemical markers were compared. The Kappa index was used to assess diagnostic sensitivity and correlation, and statistical analysis was performed using McNemar's χ test.
A total of 41 patients were included, with 41 LP samples and 41 EVD samples collected. Among the 82 samples, 29 met the diagnostic criteria for CNSIs, with 21 (72.4%) from LP samples and 8 (27.6%) from EVD samples. Among the 21 LP-diagnosed infection cases, 14 EVD samples did not meet the infection criteria, while among the 8 EVD-diagnosed infection cases, only 1 LP sample did not meet the infection criteria. The Kappa correlation index between LP and EVD diagnostic results was 0.279, and McNemar's χ test yielded = 0.001.
LP CSF demonstrates higher sensitivity than EVD CSF for early diagnosis of CNSIs in post-craniotomy patients with indwelling EVDs. In clinical practice, when EVD results are negative but there is high clinical suspicion of CNSIs, concurrent LP should be performed for further confirmation.
中枢神经系统感染（CNSIs）的早期准确诊断对临床治疗至关重要。脑脊液（CSF）分析被认为是诊断的金标准，其结果的敏感性直接影响治疗决策。然而，由于脑室和腰椎间隙脑脊液成分的生理差异，采样部位的选择可能导致诊断差异，包括假阴性。本研究旨在比较开颅术后CNSIs患者通过外部脑室引流（EVD）和腰椎穿刺（LP）获得的脑脊液样本的诊断敏感性。
本研究前瞻性收集了2024年1月至2024年12月期间接受开颅手术并放置EVD的患者的数据。对于疑似CNSIs的患者，通过LP和EVD同时采集脑脊液样本，并比较细胞计数和生化标志物的差异。使用Kappa指数评估诊断敏感性和相关性，并采用McNemar's χ检验进行统计分析。
共纳入41例患者，采集了41份LP样本和41份EVD样本。在82份样本中，29份符合CNSIs的诊断标准，其中21份（72.4%）来自LP样本，8份（27.6%）来自EVD样本。在21例经LP诊断为感染的病例中，14份EVD样本不符合感染标准，而在8例经EVD诊断为感染的病例中，只有1份LP样本不符合感染标准。LP和EVD诊断结果之间的Kappa相关指数为0.279，McNemar's χ检验结果为 = 0.001。
对于开颅术后留置EVD的患者，LP脑脊液在CNSIs的早期诊断中显示出比EVD脑脊液更高的敏感性。在临床实践中，当EVD结果为阴性但临床高度怀疑CNSIs时，应同时进行LP以进一步确诊。
