Journal
JOURNAL OF NEUROLOGICAL SURGERY PART B-SKULL BASE
Volume 75, Issue 1, Pages 18-26Publisher
THIEME MEDICAL PUBL INC
DOI: 10.1055/s-0033-1353365
Keywords
systematic review; endoscopy; endonasal; skull base; meningitis; CSF rhinorrhea
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Funding
- NeilMed Pharmaceuticals
- Carl Zeiss Pty Ltd.
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ObjectiveTo examine the risk of postoperative meningitis following expanded endoscopic endonasal skull base (EESB) surgery. SettingA systematic analysis of publications identified through searches of the electronic databases from Embase (1980-July 17, 2012), Medline (1950-July 17, 2012), and references of review articles. Main Outcome MeasuresIncidence of meningitis following EESB surgery. ResultsA total of 2,444 manuscripts were selected initially, and full-text analysis produced 67 studies with extractable data. Fifty-two contained data regarding the frequency of postoperative meningitis. The overall risk of postoperative meningitis following EESB surgery was 1.8% (36 of 2,005). For those reporting a cerebrospinal fluid (CSF) leak, meningitis occurred in 13.0% (35 of 269). For those not reporting a CSF leak, meningitis occurred in 0.1% (1 of 1,736). The odds ratio for the development of meningitis in the presence of a postoperative CSF leak was 91.99 (95% confidence interval, 11.72-721.88; p<0.01). There was no difference in reported incidence of meningitis or CSF leak between anterior and posterior cranial fossa surgery. There was one reported case of meningitis-related mortality following EESB surgery. ConclusionThe evidence in skull base surgery is limited. This study demonstrates a low incidence of meningitis (1.8%) following EESB procedures. The incidence of meningitis from EESB surgery without an associated CSF leak is uncommon.
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