Prevention of intracranial inflammatory complications in neurosurgery: literature review




intracranial inflammatory complications, prevention


The article overviews the reasoned recommendations for the prevention of intracranial inflammatory complications in patients with neurosurgical pathology, based on modern principles of evidence-based medicine.

Much attention is paid to the recommendations for reducing the risk of infection in the surgical site of intervention in the preoperative, intraoperative and postoperative periods and risk factors for the development of intracranial inflammatory complications in neurosurgical patients. The article deals with the basic principles of perioperative antibiotic prophylaxis taking into account the classification of surgical wounds in neurosurgery in accordance with the recommendations of high level of evidence.

Due to the lack of national recommendations for the prevention of intracranial inflammatory complications in neurosurgery, the publication deserves careful study and implementation in neurosurgical practice.

Author Biography

Irina P. Tkachik, Romodanov Neurosurgery Institute, Kyiv

Bacteriological Laboratory


1. van de Beek D, Drake JM, Tunkel AR. Nosocomial Bacterial Meningitis. N Engl J Med. 2010; 362:146-154. [CrossRef] [PubMed]

2. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for the prevention of surgical site infection, 1999 the Hospital Infection Control Practices Advisory Committee. Infect. Control Hosp Epidemiol. 1999; 172:68-74. [CrossRef] [PubMed]

3. Korinek AM, Baugnon T, Golmard JL. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery. 2006; 59:126-133. [CrossRef] [PubMed]

4. McClelland S III, Hall WA. Postoperative central nervous system infection: incidence and associated factors in 2111 neurosurgical procedures. Clin Infect Dis. 2007;45:55-59. [CrossRef] [PubMed]

5. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008;47:73-82. [CrossRef] [PubMed]

6. Vinchon M, Dhellemmes P. Cerebrospinal fluid shunt infection: risk factors and long-term follow-up. Childs Nerv Syst. 2006;22:692-697. [CrossRef] [PubMed]

7. Lozier AP, Sciacca RR, Romagnoli MF, Connolly ES Jr. Ventriculostomy-related infections: a critical review of the literature. Neurosurgery. 2008 Feb;62 Suppl 2:688-700. [CrossRef] [PubMed]

8. Governale LS, Fein N, Logsdon J, Black PM. Techniques and complications of external lumbar drainage for normal pressure hydrocephalus. Neurosurgery. 2008;63:Suppl 2:379-384. [CrossRef] [PubMed]

9. Baer ET. Post-dural puncture bacterial meningitis. Anesthesiology. 2006 Aug;105(2):381-93. [CrossRef] [PubMed]

10. Baltas I, Tsoulfa S, Sakellariou P, Vogas V, Fylaktakis M, Kondodimou A. Posttraumatic meningitis: bacteriology, hydrocephalus, and outcome. Neurosurgery. 1994;35:422-426. [CrossRef] [PubMed]

11. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger J. Surgical Management of Traumatic Brain Injur Surgical management of depressed cranial fractures. Neurosurgery. 2006; 58: Suppl:S56-S60. [CrossRef] [PubMed]

12. Srihawan C, Castelblanco RL, Salazar L, Wootton SH, Aguilera E, Ostrosky-Zeichner L, Sandberg DI, Choi HA, Lee K, Kitigawa R, Tandon N, Hasbun R. Clinical Characteristics and Predictors of Adverse Outcome in Adult and Pediatric Patients With Healthcare-Associated Ventriculitis and Meningitis. Open Forum Infect Dis. 2016 Apr 13;3(2):ofw077. [CrossRef] [PubMed] [PubMed Central]

13. Weisfelt M, van de Beek D, Spanjaard L, de Gans J. Nosocomial bacterial meningitis in adults: a prospective series of 50 cases. J Hosp Infect. 2007 May;66(1):71-8. Epub 2007Apr 11. [CrossRef] [PubMed]

14. Wang KW, Chang WN, Huang CR, Tsai NW, Tsui HW, Wang HC, Su TM, Rau CS. Post-neurosurgical nosocomial bacterial meningitis in adults: microbiology, clinical features, and outcomes. J Clin Neurosci. 2005 Aug;12(6):647-50. [CrossRef] [PubMed]

15. Narotam PK, van Dellen JR, du Trevou MD, Gouws E. Operative sepsis in Neurosurgery:A method of classifying surgical cases. Neurosurgery. 1994;34(3):409-415. [CrossRef] [PubMed]

16. Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb;70(3):195-283. [CrossRef] [PubMed]

17. Kourbeti IS, Jacobs AV, Koslow M, Karabetsos D, Holzman RS. Risk factors associated with postcraniotomy meningitis. Neurosurgery. 2007 Feb;60(2):317-25. [CrossRef] [PubMed]

18. Rebuck JA, Murry KR, Rhoney DH, Michael DB, Coplin WM. Infection related to intracranial pressure monitors in adults: analysis of risk factors and antibiotic prophylaxis. J Neurol Neurosurg Psychiatry. 2000 Sep;69(3):381-4. [PubMed] [PubMed Central]

19. Lietard C, Tйbaud V, Besson G. Risk factors for neurosurgical site infections: an 18-month prospective survey. J Neurosurg. 2008; 109:729–34. [CrossRef] [PubMed]

20. Korinek AM. Risk factors for neurosurgical site infections after craniotomy: a prospective multicenter study of 2944 patients. The French Study Group of Neurosurgical Infections, the SEHP, and the C-CLIN Paris-Nord. Service Epidйmiologie Hygiиne et Prйvention. Neurosurgery. 1997 Nov;41(5):1073-9; [CrossRef] [PubMed]

21. Korinek AM, Golmard JL, Elcheick A. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4578 patients. Br J Neurosurg. 2005; 19:155–62. [CrossRef] [PubMed]

22. Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G. Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery. 2008 Jan;62(1):88-95. [CrossRef] [PubMed]

23. Zabramski JM, Whiting D, Darouiche RO, Horner TG, Olson J, Robertson C, Hamilton AJ. Efficacy of antimicrobial-impregnated external ventricular drain catheters: a prospective, randomized, controlled trial. J Neurosurg. 2003 Apr; 98(4):725-30. [CrossRef] [PubMed]

24. Ragal BT, Browd SR, Schmidt RH. Surgical shunt infection: significant reduction when using intraventricular and systemic antibiotic agents. J Neurosurg. 2006; 105:242-7. [CrossRef] [PubMed]

25. Sarguna P, Lakshmi V. Ventriculoperitoneal shunt infections. Indian J Med Microbiol. 2006; 24:52-4. [CrossRef] [PubMed]

26. Langley JM, Gravel D, Moore D, Matlow A, Embree J, MacKinnon-Cameron D, Conly J. Canadian Nosocomial Infection Surveillance Program. Study of cerebrospinal fluid shunt-associated infections in the first year following placement, by the Canadian Nosocomial nfection Surveillance Program. Infect Control Hosp Epidemiol. 2009 Mar;30(3):285-8. [CrossRef] [PubMed]

27. Nisbet M, Briggs S, Ellis-Pegler R, Thomas M, Holland D. Propionibacterium acnes: an under-appreciated cause of post-neurosurgical infection. J Antimicrob Chemother. 2007 Nov;60(5):1097-103. Epub 2007 Sep 17. [CrossRef] [PubMed]

28. Conen A, Walti LN, Merlo A, Fluckiger U, Battegay M, Trampuz A. Characteristics and treatment outcome of cerebrospinal fluid shunt-associated infections in adults: a retrospective analysis over an 11-year period. Clin Infect Dis. 2008 Jul 1;47(1):73-82. [CrossRef] [PubMed]

29. Scottish Intercollegiate Guidelines Network. Antibiotic prophylaxis in surgery. pdf (accessed 2009 Jul 30 updated April 2014).

30. Callender DL. Antibiotic prophylaxis in head and neck oncologic surgery: the role of gram-negative coverage. Int J Antimicrob Agents. 1999; 12(suppl 1):s21-7. [CrossRef] [PubMed]

31. Lotfi CJ, Cavalcanti Rde C, Costa e Silva AM, Latorre Mdo R, Ribeiro Kde C, Carvalho AL, Kowalski LP. Risk factors for surgical-site infections in head and neck cancer surgery. Otolaryngol Head Neck Surg 2008;138(1):74-80. [CrossRef] [PubMed]

32. Coskun H, Erisen L, Basut O. Factors affecting wound infection rates in head and neck surgery. Otolaryngol Head Neck Surg. 2000; 123:328-33. [CrossRef] [PubMed]

33. Tabet JC, Johnson JT. Wound infection in head and neck surgery: prophylaxis, etiology and management. J Otolaryngol. 1990 Jun;19(3):197-200. Review. [PubMed]

34. Girod DA, McCulloch TM, Tsue TT, Weymuller EA Jr. Risk factors for complications in clean-contaminated head and neck surgical procedures. Head Neck. 1995 Jan-Feb;17(1):7-13. [CrossRef] [PubMed]

35. Johnson JT, Kachman K, Wagner RL, Myers EN. Comparison of ampicillin/sulbactam versus clindamycin in the prevention of infection in patients undergoing head and neck surgery. Head Neck. 1997 Aug; 19(5):367-71. [CrossRef] [PubMed]

36. Johnson JT, Yu VL. Role of aerobic gram-negative rods, anaerobes, and fungi in wound infection after head and neck surgery: Implications for antibiotic prophylaxis. Head Neck. 1989; 11(1):27-9. [CrossRef] [PubMed]

37. Brown BM, Johnson JT, Wagner RL. Etiologic factors in head and neck wound infections. Laryngoscope. 1987;97(5):587-90. [CrossRef] [PubMed]

38. Brook I. Microbiology and principles of antimicrobial therapy for head and neck infections. Infect Dis Clin N Am. 2007; 21:355-91. [CrossRef] [PubMed]

39. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol. 2011; 32(2):101-114. [CrossRef] [PubMed]

40. Berrнos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF,Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP. Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017 Aug 1;152(8):784-791. [CrossRef] [PubMed]

41. Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol. 1992 Oct;13(10):606-8. [CrossRef] [PubMed]

42. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schьnemann HJ; GRADE Working Group. Going from evidence to recommendations. BMJ. 2008 May 10;336(7652):1049-51. [CrossRef]. Erratum in: BMJ. 2008 Jun 21;336(7658): [CrossRef] [PubMed] [PubMed Central]

43. Schьnemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, Williams JW Jr, Kunz R, Craig J, Montori VM, Bossuyt P, Guyatt GH. GRADE Working Group. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008; 336(7653):1106-1110. [CrossRef] [PubMed] [PubMed Central]

44. Leclair JM, Winston KR, Sullivan BF. Effect of preoperative shampoos with chlorhexidine or iodophor on emergence of resident scalp flora in neurosurgery. Infect Control. 1988 Jan; 9(1):8-12. [CrossRef] [PubMed]

45. Winston KR. Hair and Neurosurgery. Neurosurgery. 1992;31(2):320-29. [CrossRef] [PubMed]

46. Consensus paper on the surveillance of surgical wound infections. The Society for Hospital Epidemiology of America; The Association for Practitioners in Infection Control; The Centers for Disease Control; The Surgical Infection Society. Infect Control Hosp Epidemiol. 1992 Oct; 13(10): 599-605. [CrossRef] [PubMed]

47. Kulkarni AV, Drake JM, Lamberti-Pasculli M. Cerebospinal fluid shunt infection: a prospective study of risk factors. J Neurosurgery. 2001;94:195-201. [CrossRef] [PubMed]

48. Gaskil SJ, Marlin AE. Handbook of Pediatric Neurology and Neurosurgery. Little, Brown and Company, 1993.

49. Lo CH, Spelman D, Bailey M, Cooper DJ, Rosenfeld JV, Brecknell JE. External ventricular drain infections are independent of drain duration: an argument against elective revision. J Neurosurg. 2007 Mar;106(3):378-83. [CrossRef] [PubMed]

50. Tunkel AR, Hasbun R, Bhimraj А, Byers K, Kaplan SL, Michael Scheld W, van de Beek D, Bleck TP, Garton HJ, Zunt JR. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis Clin Infect Dis. 2017;64(6):e34-e65. [CrossRef] [PubMed]

51. Renier D, Lacombe J, Pierre-Kahn A, Sainte-Rose C, Hirsch JF. Factors causing acute shunt infection. J Neurosurg. 1984;61:1072-1078. [CrossRef] [PubMed]

52. Tenney JH, Vlahov D, Sachman M, Ducker TB. Wide variation in risk of wound infection found in clean neurosurgery. Implication for perioperative antibiotic prophylaxis. J Neurosurg. 1985;62:243-247. [CrossRef] [PubMed]

53. van Aken MO, de Marie S, van der Lely AJ, Singh R, van den Berge JH, Poublon RM, Fokkens WJ, Lamberts SW, de Herder WW. Risk factors for meningitis after transsphenoidal surgery. Clin Infect Dis. 1997 Oct;25(4):852-6. [CrossRef] [PubMed]



How to Cite

Tkachik, I. P. (2017). Prevention of intracranial inflammatory complications in neurosurgery: literature review. Ukrainian Neurosurgical Journal, (4), 24–30.



Review articles