A Systematic Review and Meta-Analysis of Meningitis Risk Reduction After Repair of Spontaneous Lateral Skull Base Cerebrospinal Fluid Leaks.

IF 2 3区医学 Q3 CLINICAL NEUROLOGY

Otology & Neurotology Pub Date : 2025-10-03 DOI:10.1097/MAO.0000000000004602

Khadija Khan, Prishae Wilson, Mayuri S Patel, Estephania Candelo, Zhen Wang, Tara Brigham, Mallory Raymond

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引用次数: 0

Abstract

Objective: To estimate the relative risk of meningitis after repair of spontaneous lateral skull base cerebrospinal fluid (CSF) leaks through meta-analysis of published studies.

Databases reviewed: PubMed, Medline, Embase, Cochrane, SCI-EXPANDED, ESCI, Epistemonikos, and WHO Global Index Medicus were queried for terms including and related to meningitis, CSF leak, surgery, and spontaneous from inception to April 02, 2024.

Methods: Prospective and retrospective studies in any language reporting either preoperative or postoperative rates of meningitis in adults with spontaneous lateral skull base CSF leaks were included. Two reviewers independently screened 2,564 studies and extracted data and evaluated risk of bias in 57 studies that met inclusion criteria. A random effects generalized linear mixed model was used to pool and compare logit transformed risk of meningitis before and after repair.

Results: Of 1,310 patients who met inclusion criteria, 1,239 underwent CSF leak repair. Fifty-two studies reported rates of preoperative meningitis, and 27 studies reported rates of postoperative meningitis. Twenty-two studies with a total of 511 patients reported both rates. The average follow-up period of 17 studies reporting duration of follow-up was 23.1 months. The preoperative pooled risk of meningitis was 0.16 (95% CI: 0.13-0.25, I2 = 40.57%). The postoperative pooled risk was considerably lower at 0.01 (95% CI: 0.01-0.14, I2 = 4.16%). With substantial heterogeneity (I2 = 62.94%), we observed a relative risk of meningitis after repair of 0.02 (95% CI: 0.00-0.79, p = 0.04).

Conclusion: Surgical repair of spontaneous lateral skull base CSF leaks may significantly reduce the risk of adult meningitis.

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自发性颅底外侧脑脊液泄漏修复后降低脑膜炎风险的系统回顾和荟萃分析

目的：通过对已发表研究的荟萃分析，估计自发性侧颅底脑脊液（CSF）泄漏修复后发生脑膜炎的相对风险。检索数据库：PubMed、Medline、Embase、Cochrane、SCI-EXPANDED、ESCI、Epistemonikos和WHO全球索引Medicus，查询从成立到2024年4月2日与脑膜炎、脑脊液泄漏、手术和自发性相关的术语。方法：采用前瞻性和回顾性研究，以任何语言报道自发性颅底外侧脑脊液泄漏的成人脑膜炎术前或术后发生率。两名审稿人独立筛选了2564项研究，提取了数据，并评估了符合纳入标准的57项研究的偏倚风险。随机效应广义线性混合模型用于汇总和比较修复前后脑膜炎logit转化风险。结果：在1310例符合纳入标准的患者中，1239例接受了脑脊液泄漏修复。52项研究报告了术前脑膜炎的发生率，27项研究报告了术后脑膜炎的发生率。22项共511例患者的研究报告了这两种发生率。17项研究的平均随访时间为23.1个月。术前合并脑膜炎风险为0.16 （95% CI: 0.13-0.25, I2 = 40.57%）。术后合并风险显著降低，为0.01 （95% CI: 0.01-0.14, I2 = 4.16%）。由于存在很大的异质性（I2 = 62.94%），我们观察到修复后发生脑膜炎的相对风险为0.02 （95% CI: 0.00-0.79, p = 0.04）。结论：手术修复自发性颅底外侧脑脊液渗漏可显著降低成人脑膜炎的发病风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Otology & Neurotology 医学-耳鼻喉科学

CiteScore

3.80

自引率

14.30%

发文量

509

审稿时长

3-6 weeks

期刊介绍： Otology & Neurotology publishes original articles relating to both clinical and basic science aspects of otology, neurotology, and cranial base surgery. As the foremost journal in its field, it has become the favored place for publishing the best of new science relating to the human ear and its diseases. The broadly international character of its contributing authors, editorial board, and readership provides the Journal its decidedly global perspective.