The role of prophylaxis antibiotics in the prevention of meningitis in endonasal anterior skull base surgery, a systematic review and meta-analysis

Objectives Anterior skull base surgery is commonly used for the surgical treatment of a variety of skull base lesions. One uncommon, but serious post-operative complication of this procedure is meningitis. Prophylactic antibiotics are widely used but with considerable variability in duration and regimes due to lack of guidelines. This systematic review was carried out to determine the benefit of prophylactic antibiotics in preventing meningitis in patients undergoing endonasal anterior skull base surgery. Methodology The review was undertaken according to PRISMA guidelines. Online searches including PubMed, MEDLINE, EMBASE, Cochrane and grey literature were performed up to 2nd May 2024. Articles reporting on patients undergoing endoscopic anterior skull base surgery, the use or not of prophylactic antibiotics and follow up outcomes were included for selection. Data extracted included demographics, pathology, prophylactic antibiotic duration/type, nasal pack use, CSF leaks, meningitis rates, sinusitis rates and other complications. Results 32 studies were included in this systematic review, totaling 26,477 patients published between 1981-2023. The overall rate of developing meningitis with any duration of use of antibiotics was 2%. Patients receiving intra-operative antibiotics alone had a higher rate of subsequent meningitis (3%) compared to patients receiving a post-operative course of 24 hours or a longer course (1%). Patients who had an intra-operative or post-operative CSF leak had a higher rate of meningitis (10%) than those without (0%). Conclusions This review indicates that post-operative antibiotic course may be more effective in preventing meningitis. Patients who develop a CSF leak have a higher risk of developing meningitis.

Publication History

Received: 26 February 2025

Accepted after revision: 12 May 2025

Accepted Manuscript online:
14 May 2025