Risk factors for postoperative meningitis after microsurgery for vestibular schwannoma.

Bowen Huang,Yanming Ren,Xuhui Hui,Yuekang Zhang,Wenke Liu,Zhigang Lan,Chenghong Wang,Jonathan H. Sherman

doi:10.1371/journal.pone.0217253

Bowen Huang, Yanming Ren + Show 6 more

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https://doi.org/10.1371/journal.pone.0217253

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Abstract

ObjectiveMeningitis after microsurgery for vestibular schwannoma (VS) is a severe complication that results in high morbidity. However, few studies have focused on meningitis after VS surgery. The purpose of this study was to identify the risk factors for meningitis after VS surgery.MethodsWe performed a retrospective analysis of all VS patients who underwent microsurgery and survived for at least 7 days after surgery, between 1 June 2015 and 30 November 2018 at West China Hospital of Sichuan University. Univariate and multivariate analyses were performed to identify the risk factors for postoperative meningitis (POM).ResultsWe enrolled 410 patients, 27 of whom had POM. Through univariate analysis, the factors of hydrocephalus (p = 0.018), Koos grade IV (p = 0.04), operative duration > 3 hours (p = 0.03) and intraoperative bleeding volume ≥400 ml (p = 0. 02) were significantly correlated with POM. The multivariate analysis showed that Koos grade IV (p = 0.04; OR = 3.19; 95% CI 1.032–3.190), operation duration > 3 hours (p = 0.03; OR = 7.927; 95% CI 1.043–60.265), and intraoperative bleeding volume ≥ 400 ml (p = 0.02; OR = 2.551; 95% CI 1.112–5.850) were the independent influencing factors of POM.ConclusionsKoos grade IV, operation duration > 3 hours, and intraoperative blood loss ≥ 400 ml were identified as independent risk factors for POM after microsurgery for VS. POM also caused a prolonged hospital stay.

Highlights

Vestibular schwannoma (VS), referred to as acoustic neuroma (AN), is a histopathologically benign tumor arising from Schwann cells surrounding the vestibular nerve[1]
The multivariate analysis showed that Koos grade IV (p = 0.04; OR = 3.19; 95% CI 1.032–3.190), operation duration > 3 hours (p = 0.03; OR = 7.927; 95% CI 1.043–60.265), and intraoperative bleeding volume 400 ml (p = 0.02; OR = 2.551; 95% CI 1.112–5.850) were the independent influencing factors of postoperative meningitis (POM)
Koos grade IV, operation duration > 3 hours, and intraoperative blood loss 400 ml were identified as independent risk factors for POM after microsurgery for VS

Summary

Introduction

Vestibular schwannoma (VS), referred to as acoustic neuroma (AN), is a histopathologically benign tumor arising from Schwann cells surrounding the vestibular nerve[1]. The incidence of VS is estimated to be 1.9 per 100,000 per year[2]. The frequency of postoperative complications remains high. Meningitis is the main fatal complication after craniocerebral surgery. The data show that the incidence of postoperative meningitis (POM) following vestibular schwannoma surgery is approximately 5.5%-9.85%[4,5,6,7,8]. In the event of POM, the mortality can be as high as 50%[9]. Related research on the clinical risk factors of meningitis after acoustic neuroma surgery is limited

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