Risk of Post-Neurosurgical Meningitis by Glioma Grade: A Retrospective Study

Overview

This retrospective cohort study analyzed 345 glioma patients undergoing craniotomy to assess the incidence of post-neurosurgical meningitis (PNM) and its association with glioma grade. The study identified 25 cases of PNM and evaluated risk factors including reoperations and clinical parameters in a Finnish tertiary center.

Background

Gliomas represent approximately 80% of malignant brain tumors, with high-grade gliomas (grades 3–4) comprising 85% of cases and associated with poor survival rates. Post-neurosurgical meningitis (PNM) is a serious complication after craniotomy, occurring in 2–9% of cases and contributing to morbidity and mortality. Risk factors for PNM include reoperations, CSF leaks, corticosteroid use, and immune status, which may vary by glioma grade. Understanding the relationship between glioma grade and PNM risk is critical for optimizing perioperative management.

Data Highlights

Key Findings

• PNM incidence in glioma surgery patients was identified at approximately 7.2% (25/345).
• Reoperations and revision surgeries were significant risk factors for developing PNM.
• Both low-grade and high-grade glioma patients received similar perioperative antibiotic prophylaxis and surgical sterilization protocols.
• PNM diagnosis required clinical symptoms plus CSF criteria including culture positivity, elevated leukocytes, or lactate levels.
• Prevention of CSF leak via meticulous surgical technique is critical to reduce PNM risk.
• Gram-positive bacteria remain common pathogens, but gram-negative organisms are increasingly reported in PNM cases.

Clinical Implications

Clinicians should maintain heightened vigilance for PNM in glioma patients, especially those undergoing reoperations or revision surgeries. Standardized prophylactic antibiotic regimens and meticulous surgical techniques to prevent CSF leaks are essential. Early recognition and diagnosis using clinical and CSF parameters can facilitate timely management to reduce morbidity.

Conclusion

This study highlights the importance of glioma grade and surgical factors in the risk of post-neurosurgical meningitis. Optimizing perioperative care and infection prevention strategies tailored to glioma patients can improve outcomes.

References

1. Turku University Hospital Glioma Study 2011-2018 -- Risk of Meningitis Following Neurosurgery in Relation to Glioma Grade