Viral immunological complications in neurological surgery: A comprehensive review of homeostatic disturbances and cognitive impairments.

Background: Neurosurgical procedures are essential for treating various brain and spinal conditions, but they also carry the risk of infections, including viral infections. These infections can disrupt brain homeostasis, leading to cognitive impairments. During surgery, protective barriers like the blood-brain barrier (BBB) can be compromised, and cerebrospinal fluid may be exposed to pathogens. This makes the brain more susceptible to viral infections, which can trigger inflammation. Over time, this inflammation can have lasting effects on cognitive function, impacting the brain's ability to maintain neural integrity.

Methods: A review of the literature was performed using PubMed, Google Scholar, Scopus, and Web of Science from inception to January 2025. We focus on the impact of viral infections after neurosurgical procedures and how these infections lead to neuroinflammation.

Results: Viral infections after neurosurgery activate neuroinflammatory responses, with microglia and astrocytes playing a key role. The release of cytokines such as tumor necrosis factor-alpha and interleukin-1 causes significant neuronal damage, impairing synaptic function and connectivity. This inflammatory process, combined with BBB disruption, leads to cognitive dysfunction both in the immediate postoperative period and in the long-term. Understanding these processes is essential for addressing cognitive decline in patients who have undergone neurosurgery.

Conclusion: Viral infections following neurosurgery are a significant risk factor for cognitive decline. Neuroinflammation, especially when coupled with BBB disruption, contributes to both short-term and long-term cognitive impairments. This review highlights the need for targeted interventions to control inflammation and protect the BBB in the perioperative period. Future research focused on neuroprotective therapies, including anti-inflammatory agents and strategies to preserve BBB integrity, is critical for improving cognitive outcomes in neurosurgical patients.