Oleg Sharipov

Abstract

Introduction:

Endoscopic transsphenoidal surgeries are performed through a conditionally clean surgical wound, which carries a high risk of postoperative meningitis. This can lead to worsened clinical outcomes and increased financial costs of treatment.

Methods:

A prospective observational study included patients who underwent tumor resection via an expanded transsphenoidal approach. Pre-, intra-, and postoperative risk factors for meningitis were evaluated, along with skull base closure techniques and their impact on meningitis rates.

Results:

The study enrolled patients aged >18 years: 143 females (63.8%) and 81 males (36.2%). From August 2021 to November 2024, 224 expanded transsphenoidal approaches were performed:

• Anterior expanded approach: 156 cases (69.6%),


• Posterior expanded approach: 46 cases (20.5%),


• Lateral approach: 19 cases (8.5%),


• Transseptal approach: 3 cases (1.3%).

Meningitis occurred in 41 cases (18.3%). Of 37 patients with confirmed meningitis, microbial growth was detected in 27 (73.0%):

• Gram-positive flora: 15 cases (55.6%; one case involved two organisms),


• Gram-negative flora: 14 cases (51.7%).
  
  Notably, 11 infections (40.7%) were caused by urogenital/GI tract pathogens.

Risk factors for meningitis:

• Duration of neurosurgery (*p* = 0.014),


• Time between antibiotic prophylaxis and transnasal access initiation (*p* = 0.025),


• Use of a balloon for skull base reinforcement (*p* = 0.0375).

Closure materials and pathogen-specific risks:

• TachoSil: Higher risk of Staphylococcus aureus meningitis (*p* = 0.00781),


• Hemostatic sponge: Associated with Klebsiella pneumoniae (*p* = 0.0476) and Proteus mirabilis (*p* = 0.0345),


• Nasal packing: Linked to Proteus mirabilis (*p* = 0.046).

Conclusion:

Ongoing monitoring is required to identify non-obvious factors predisposing to meningitis.