Preoperative Chronic or Acute Purulent Sinusitis Is Not Associated with the Development of Post Operative Meningitis in Endonasal Skull Base Surgery

Introduction: Traditional dictum has raised caution to performing endonasal skull base surgery in the face of sinusitis. The aim of this study was to determine if preoperative sinusitis, either radiographic or culture-positive sinusitis was a risk factor for post operative meningitis.

Methods: Retrospective review was performed of all endonasal skull base cases with dural exposure at our institution from October 2009 until August 2013. In total, 400 cases were reviewed and classified into procedures without preoperative radiographic evidence of sinusitis, preoperative evidence of sinusitis either acute (presence of air fluid levels) or chronic (mucosal thickening with or without fluid or polyps), and were further classified as to presence of intraoperative cerebrospinal fluid leaks (CSF), either primary or secondary graded by the Kelly grading system and sinus culture positive procedures. These findings were correlated with the subsequent postoperative culture-positive or aseptic meningitis.

Results: Of 400 procedures, 318 (80%) demonstrated no evidence of sinusitis and 82 (20%) demonstrated acute or chronic sinusitis on preoperative imaging. Primary CSF leaks were repaired in seven patients (7); intraoperative CSF leaks occurred in 176 procedures (44%) divided into Grade 1 (60 procedures, 15%), Grade 2 (68 procedures, 17%) and Grade 3 (47 procedures, 12%). Primary or intraoperative CSF leaks occurred with radiographic evidence of sinusitis in 45 cases (11%) and sinus culture positive procedures in 12 cases (3%). Postoperative culture-positive meningitis occurred in 3 patients (0.075%) and aseptic meningitis in 3 patients (0.075%), 6 patients in total (1.5%) . No patients with postoperative culture-positive or aseptic meningitis had either radiographic or culture-positive sinusitis. Of these 6 meningitis patients, 5 had grade 3 intraoperative CSF Leaks, 5 had extended skull base approaches, 2 had prior surgery and none had postoperative CSF leaks.

Conclusions: This data suggests that postoperative meningitis in endonasal skull base surgery appears to be unrelated to the presence of radiographic or culture-positive sinusitis and is likely related to other etiologies.