Systemic antibiotic prophylaxis in neurological surgery.

The clinical and experimental bases for antibiotic prophylaxis in surgery are reviewed briefly. The evidence regarding antibiotic prophylaxis in five specific neurosurgical situations (clean surgical procedures, cerebrospinal fluid shunts, external venticulostomies, basilar skull fractures, and compound skull fractures) is examined. There are no unequivocal indications for antibiotic prophylaxis in neurological surgery. Large scale randomized clinical trials will be required to settle the controversy in some of these areas.