title: Association between cerebrospinal fluid leak and meningitis after skull base surgery.
abstract: BACKGROUND
  Meningitis and cerebrospinal fluid (CSF) leak are serious complications of skull base surgery, but whether postoperative CSF leak increases the risk of meningitis is unknown.
  
  
  OBJECTIVE
  To evaluate any association between meningitis and CSF leak after open or endoscopic skull base resection.
  
  
  METHODS
  A retrospective case series with chart review in a tertiary care university-affiliated medical center.
  
  
  METHODS
  A total of 156 patients underwent intradural tumor resection in our institution between 1994 and 2009, 135 (86%) via the subcranial approach and 21 (14%) through the expanded endonasal approach. All occurrences of meningitis, brain abscess, and CSF leak had been recorded and were available for analysis.
  
  
  RESULTS
  Nine patients (5.7%) had postoperative meningitis, and 3 patients had postoperative CSF leak (1.9%). The risk of meningitis in patients without CSF leak was 4.5% (7/153) compared to 66% (2/3) in those with CSF leak. A statistical analysis revealed a significant association between CSF leak and meningitis, with a relative risk of 14.6 (95% confidence interval, 4.95-42; P = .008).
  
  
  CONCLUSIONS
  Postoperative CSF leak significantly increases the risk of meningitis. Most cases of meningitis after skull base operation are probably associated with lumbar drainage infection or from an obscure leak.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Gilad
authors.initials: G
authors.lastname: Horowitz
authors.forename: Dan M
authors.initials: DM
authors.lastname: Fliss
authors.forename: Nevo
authors.initials: N
authors.lastname: Margalit
authors.forename: Oshri
authors.initials: O
authors.lastname: Wasserzug
authors.forename: Ziv
authors.initials: Z
authors.lastname: Gil
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002558:Cerebrospinal Fluid Otorrhea / Q000453:epidemiology*; D004677:Encephalocele / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D018304:Esthesioneuroblastoma, Olfactory / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008581:Meningitis / Q000453:epidemiology* / Q000503:physiopathology; D008588:Meningocele / Q000601:surgery; D008875:Middle Aged; D009296:Nasal Cavity; D009669:Nose Neoplasms / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D019291:Skull Base / Q000601:surgery*