Impact of the lumbar catheter on the incidence of post-surgical meningitis in the endoscopic endonasal approach

Objectives: Endoscopic endonasal approach (EEA) procedures are inherently contaminated due to direct access through the nasopharyngeal mucosa. The reported rate of postoperative meningitis in EEA procedures is between 0.7%-10%. Lumbar catheters are used in EEA surgeries to prevent cerebrospinal fluid (CSF) fistulae, but its use is associated with increase infection rates. This study investigated whether there is a difference in rates of postoperative meningitis based on lumbar catheter utilization. Methods: We performed a retrospective review of consecutive patients who underwent EEA surgeries between January 2016 and March 2023 at single-institution (FLENI). Main outcome: Incidence of meningitis following EEA surgery with lumbar catheter. Results: seventy-two patients were enrolled, median age was 44 years, and 53% were female. Most frequent surgery performed was craniopharyngioma 46% (26 patients). Lumbar catheter was used in twenty-eight patients. Meningitis was diagnosis in 11 of 72 patients (15.2%), being higher in the lumbar catheter group (10 patients). The odds ratio for the development of meningitis in the presence of a lumbar catheter was 23.38 (95% confidence interval, 2.77-123.78; p < 0.004). There was no statistical difference in reported incidence of meningitis when CSF leak was present. Conclusions: This study demonstrates an extremely high incidence of meningitis (36%) following EEA procedures when lumbar catheter is used. The incidence of meningitis was not significantly associated with CSF leak in our cohort.