Dynamic curve analysis of indicators related to lumbar cistern drainage for postoperative meningitis

Abstract Background Lumbar cisterna drainage (LCD) is widely used in neurosurgery as an effective treatment for postoperative meningitis, vasospasm of subarachnoid hemorrhage and ventricular system hemorrhage, and for reducing intracranial pressure in patients with severe craniocerebral trauma. The purpose of this work was two-fold: to analyze the dynamic curve of cerebrospinal fluid (CSF) related indices in cases of postoperative meningitis after selective craniotomy and to provide reference data for the clinical treatment with LCD. Methods We conducted a retrospective study of LCD placement in patients who underwent either supratentorial craniotomy (n=23) or subtentorial craniotomy (m=28). Primary outcomes measured included pre-intervention and post-intervention dynamic changes of body temperature, and CSF biochemical parameters (white blood cell (WBC) count, polykaryocyte percentage, protein, glucose and chloride) over the course of 13 days of catheter placement. We also assessed the bivariate correlation between WBC count changes, polykaryocyte percentage, body temperature and daily CSF drainage volume. Finally, we analyzed the effect of average daily drainage volume, antibiotic choice, and surgical site on the WBC count change curves. Results After LCD, a trend of increased WBC count was observed on the first day of drainage, followed by an overall decrease in WBC count. There was a statistically significant ( P<0.05 ) difference between the WBC count before drainage and the WBC count on the fourth day of drainage. Polykaryocyte percentage decreased initially and then increased progressively each day after drainage. There was a negative correlation between the change curve of the WBC count and the curve of daily drainage volume (r = -0.56). When the daily drainage volume was 250-300 ml/d, the change curve pattern of the WBC count was consistent with the overall trend of the WBC count, and there was no significant difference in the curve of the WBC count between different surgical sites ( P > 0.05 ). Conclusions LCD is an effective method for the treatment of postoperative meningitis. The WBC count can decrease significantly by the fourth day after drainage, and placement of the LCD for six to seven days is ideal. An average drainage volume of 250-300 ml/d is safe and effective.