Authors: Luciano Falcão, Ocílio Ribeiro Gonçalves, Gabriel Arruda, Isabelle Rodrigues Menezes, et al.

Journal: Neurosurgical Review (2026; 49). Online publication: October 17, 2026.

Study design: Systematic review and meta-analysis (14 studies; 7,981 patients).

DOI: 10.1007/s10143-026-04537-x · PubMed (PMID: 42891871)

Key findings

The pooled incidence of postoperative meningitis after endoscopic endonasal skull base surgery was 1.38% (95% CI 0.92–2.08%). Among studies with classifiable antibiotic-duration protocols, meningitis incidences were 1.24% for ultra-short prophylaxis (≤1 day), 1.20% for short prophylaxis (1–3 days), and 2.12% for longer prophylaxis (>3 days), without a statistically significant difference between subgroups (p = 0.764).

Meta-regression found no significant association between prophylaxis duration and meningitis (p = 0.487). A higher study-level proportion of intraoperative CSF leaks was associated with greater postoperative meningitis incidence (p = 0.010).

Why it matters for skull base surgery

These findings raise an important practical question regarding routine prolonged antibiotic prophylaxis and highlight the potential importance of operative risk factors, particularly intraoperative CSF leakage, when considering infection-prevention strategies.

Interpretation: These are study-level observational findings, not proof of equivalence between antibiotic regimens or a basis for changing an individual patient’s prophylaxis without evaluating the clinical context and local protocols.