The Role of Prophylaxis Antibiotics in the Prevention of Meningitis in Endonasal Anterior Skull Base Surgery: A Systematic Review and Meta-analysis

Abstract

Objectives

Anterior skull base surgery is commonly used for the surgical treatment of a variety of skull base lesions. One uncommon, but serious postoperative 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.

Methods

The review was undertaken according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Online searches including PubMed, MEDLINE, EMBASE, Cochrane, and gray literature were performed up to May 2, 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, cerebrospinal fluid (CSF) leaks, meningitis rates, sinusitis rates, and other complications.

Results

A total of 32 studies were included in this systematic review, totaling 26,477 patients published between 1981 and 2023. The overall rate of developing meningitis with any duration of use of antibiotics was 2%. Patients receiving intraoperative antibiotics alone had a higher rate of subsequent meningitis (3%) compared with patients receiving a postoperative course of 24 hours or a longer course (1%). Patients who had an intraoperative or postoperative CSF leak had a higher rate of meningitis (10%) than those without (0%).

Conclusion

This review indicates that postoperative antibiotic course may be more effective in preventing meningitis. Patients who develop a CSF leak have a higher risk of developing meningitis.

Keywords

meningitis - prophylactic antibiotics - skull base surgery - transsphenoidal surgery - CSF leak

^* The authors contributed equally to the publication as co-first authors.

Publication History

Received: 26 February 2025

Accepted: 12 May 2025

Accepted Manuscript online:
14 May 2025

Article published online:
09 June 2025

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