RISK-FACTORS FOR MENINGITIS AFTER TRANSSPHENOIDAL SURGERY

To evaluate possible risk factors for meningitis, we retrospectively r eviewed 228 transsphenoidal operations (in which a standard regimen of amoxicillin prophylaxis was used) for sellar pathology. The incidence of meningitis was 3.1% (seven of 228 cases), Cultures of preoperative specimens from the anterior nasal vestibule in three of seven patient s yielded Staphylococcus aureus; but none of these patients developed S. aureus meningitis. Two of three patients with significant preoperat ive paranasal sinus abnormalities developed meningitis compared with o nly five of 225 patients without significant paranasal sinus abnormali ties (P < .005). Three of 22 patients with intraoperative cerebrospina l fluid (CSF) leakage developed meningitis compared with four of 206 p atients without intraoperative CSF leakage (P < .05). Six of seven pat ients with postoperative CSF rhinorrhea and only one of 221 patients w ithout postoperative CSF rhinorrhea developed meningitis (P < .00001), In conclusion, postoperative CSF leakage is an important risk factor for meningitis after transsphenoidal surgery. Cultures of preoperative specimens from the anterior nasal vestibule did not have any predicti ve value in our study.