Bacterial meningitis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aysha Anwar, M.B.B.S[2]


There is no role of surgery in the management of uncomplicated bacterial meningitis. However, surgical asssistance may be required in the patients unresponsive to medical therapy such as failure of drug transport to CSF or occlusion of fourth ventricle outlets by pus, traumatic injuries such as compound fractures of skull or penetrating wounds of CNS and management of complications of bacterial meningitis such as hydrocephalus, subdural effusions, intraventricular septations.[1][2]


There is no role of surgery in the treatment of uncomplicated bacterial meningitis. However, neurosurgical assistance may be required in the following conditions:[1][2][3] Complications of bacterial meningitis

  • Complications such as hydrocephalus, brain abscess, subdural effusions, intraventricular septation and dural venous sinus thrombosis.
  • Following surgical procedures may be perfomed in patients having complications of meningitis.
  • Ventricular drainage for increased intracranial pressure
  • Aspiration or surgical excision of abscess
  • Procedures for dural venous sinus thrombosis such as radical mastoidectomy

Unresponsive to medical therapy

  • Fourth ventricle outlet blockade by pus
  • Failure of drug transport to CSF

Traumatic injuries

  • Compound fractures of skull or spine
  • Penetrating injuries of the CNS

Surgically treatable lesions complicating meningitis

  • Congenital conditions such as spina bifida cystica and encephalocele
  • Inflammatory conditions such as infected CSF ary shunt


  1. 1.0 1.1 Humphreys RP (1975). "Surgical management of bacterial meningitis". Can Med Assoc J. 113 (6): 536–8. PMC 1956741. PMID 1098760.
  2. 2.0 2.1 Pfister HW, Feiden W, Einhäupl KM (1993). "Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study". Arch Neurol. 50 (6): 575–81. PMID 8503793.
  3. Kastenbauer S, Pfister HW (2003). "Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases". Brain. 126 (Pt 5): 1015–25. PMID 12690042.

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