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Background <p>Postoperative meningitis remains an important complication following pediatric posterior fossa tumor (PPFT) surgery and is associated with increased morbidity, prolonged hospitalization, and delays in adjuvant therapy. However, data regarding its incidence and perioperative risk factors in children remain limited.</p> Objectives <p>To determine the incidence, risk factors, microbiological profile, and cerebrospinal fluid (CSF) characteristics of postoperative meningitis in PPFTs.</p> Methodology <p>A retrospective analysis of 116 PPFT cases was performed. Patients with postoperative meningitis were compared with those without meningitis to identify potential risk factors. Meningitis cases were further classified into culture-positive and culture-negative groups, and CSF biochemical and cytological parameters were analyzed. Statistical analysis was performed with significance set at <i>p</i> &lt; 0.05.</p> Results <p>Among 116 patients (age = 9 ± 4&#xa0;years; male:female::2.2:1), postoperative meningitis occurred in 19 (16.4%). Emergency surgery was significantly associated with meningitis (11/19, 57.9% vs 27/97, 27.8%; <i>p</i> = 0.011). Wound complications were more frequent in meningitis patients (52.6% vs 29.9%, <i>p</i> = 0.055). Age, tumor location, raised intracranial pressure, preoperative external ventricular drainage, shunt placement, postoperative CSF leak, intraventricular hemorrhage (IVH), and leukocyte count were not significantly associated. Among meningitis cases, 6 were culture-positive and 13 culture-negative. Bacterial meningitis showed higher median CSF cell counts (415 vs 12.5 cells/mm<sup>3</sup>, <i>p</i> = 0.082) and protein levels (139.3 vs 71.05&#xa0;mg/dL, <i>p</i> = 0.190). IVH was more frequent in bacterial meningitis (33.3% vs 0%, <i>p</i> = 0.028). The most common isolates were <i>Klebsiella</i> species and methicillin-resistant <i>Staphylococcus aureus </i>(MRSA).</p> Conclusion <p>Postoperative meningitis occurred in one-sixth of pediatric PFT cases. Emergency surgery independently increased risk, while culture-positive cases showed intraventricular hemorrhage and higher CSF inflammatory indices. The microbial profile highlights the increasing prevalence of multidrug-resistant organisms.</p>

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Postoperative meningitis in pediatric posterior fossa tumors: risk stratification and the role of early CSF cytology

  • 期刊论文

  • 发表日期：

    2026年8月4日

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  • Srishti Dixit,
  • Ashutosh Kumar,
  • Aanchal Datta,
  • Deepti Tripathi,
  • Soumen Kanjilal,
  • Pawan Kumar Verma,
  • Ved Prakash Maurya,
  • Kuntal Kanti Das,
  • Anant Mehrotra,
  • Arun Kumar Srivastava,
  • Awadhesh Kumar Jaiswal

摘要

Background

Postoperative meningitis remains an important complication following pediatric posterior fossa tumor (PPFT) surgery and is associated with increased morbidity, prolonged hospitalization, and delays in adjuvant therapy. However, data regarding its incidence and perioperative risk factors in children remain limited.

Objectives

To determine the incidence, risk factors, microbiological profile, and cerebrospinal fluid (CSF) characteristics of postoperative meningitis in PPFTs.

Methodology

A retrospective analysis of 116 PPFT cases was performed. Patients with postoperative meningitis were compared with those without meningitis to identify potential risk factors. Meningitis cases were further classified into culture-positive and culture-negative groups, and CSF biochemical and cytological parameters were analyzed. Statistical analysis was performed with significance set at p < 0.05.

Results

Among 116 patients (age = 9 ± 4 years; male:female::2.2:1), postoperative meningitis occurred in 19 (16.4%). Emergency surgery was significantly associated with meningitis (11/19, 57.9% vs 27/97, 27.8%; p = 0.011). Wound complications were more frequent in meningitis patients (52.6% vs 29.9%, p = 0.055). Age, tumor location, raised intracranial pressure, preoperative external ventricular drainage, shunt placement, postoperative CSF leak, intraventricular hemorrhage (IVH), and leukocyte count were not significantly associated. Among meningitis cases, 6 were culture-positive and 13 culture-negative. Bacterial meningitis showed higher median CSF cell counts (415 vs 12.5 cells/mm3, p = 0.082) and protein levels (139.3 vs 71.05 mg/dL, p = 0.190). IVH was more frequent in bacterial meningitis (33.3% vs 0%, p = 0.028). The most common isolates were Klebsiella species and methicillin-resistant Staphylococcus aureus (MRSA).

Conclusion

Postoperative meningitis occurred in one-sixth of pediatric PFT cases. Emergency surgery independently increased risk, while culture-positive cases showed intraventricular hemorrhage and higher CSF inflammatory indices. The microbial profile highlights the increasing prevalence of multidrug-resistant organisms.