Infectious complications of temporary spinal catheter insertion for diagnosis of adult hydrocephalus and idiopathic intracranial hypertension.
OBJECTIVE
Spinal catheters are often inserted for treatment of cerebrospinal fluid leaks; however, they have recently been recommended for elective cerebrospinal fluid drainage to identify patients with possible normal pressure hydrocephalus who are most likely to respond to shunt surgery. The rate of spinal catheter-associated meningitis with elective spinal catheter insertion is unknown. The objective was to determine the rate of infection and risk factors associated with elective spinal catheter insertion for evaluation of hydrocephalus and idiopathic intracranial hypertension (IIH).


METHODS
We retrospectively analyzed clinical and microbiological data and cerebrospinal fluid results of patients admitted during 60 consecutive months who had elective spinal catheter insertion for evaluation of normal pressure hydrocephalus or IIH.


RESULTS
A total of 461 spinal catheters were inserted in 454 patients, including 419 (90.9%) for treatment of hydrocephalus and 42 (9.1%) for IIH. The infection rate was 3.3% (15 out of 461 patients) for the entire cohort, 3.6% (15 out of 419 patients) for the hydrocephalus cohort, and 0% for the IIH cohort. There was one death (0.2%) in the hydrocephalus cohort. The infection rate was reduced and sustained at 1.8% for 225 catheters after the topical antiseptic was changed to chlorhexidine (two-sided Fisher's exact test; P = 0.114).


CONCLUSIONS
Although infection is the most serious complication of spinal catheter insertion for evaluation of hydrocephalus or IIH, the infection rate can be maintained below 2% with use of chlorhexidine topical antiseptic application, single-dose preprocedural antibiotic administration, and clinical surveillance of the patient. The benefit of cerebrospinal fluid drainage via spinal catheter for normal pressure hydrocephalus outweighs the risks associated with the procedure.
Greenberg
Benjamin M
BM
Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
Williams
Michael A
MA
D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis*; D008297:Male; D008581:Meningitis / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged; D011183:Postoperative Complications; D011559:Pseudotumor Cerebri / Q000175:diagnosis*; D012189:Retrospective Studies