Investigation and management of an intracranial infection event after endoscopic microvascular decompression for treatment of trigeminal neuralgia

OBJECTIVE To investigate the causes of intracranial infection after endoscopic microvascular decompression for the treatment of trigeminal neuralgia in a teaching hospital.

METHODS An epidemiological survey was conducted on 2 patients (F and Z) who developed intracranial infections after microvascular decompression for trigeminal neuralgia in the department of neurosurgery of the Affiliated Hospital of Qingdao University in July 2024. Bacteriological sampling and culture were carried out for the staff, environment and materials involved in the surgery. The homology of strains between the strains recovered from the patients and those from the environmental was analyzed by means of pulsed-field gel electrophoresis (PFGE) and second-generation illumina sequencing.

RESULTS All the three electric razors that were used for preoperative shaving of the patients were found to be contaminated with Enterobacter hormaechei and Klebsiella pneumoniae. Enterobacter hormaechei strain (E1) and K. pneumoniae strains (K1 to K4) were isolated from the cerebrospinal fluid of patient F. Enterobacter hormaechei strains (E2 and E3) were isolated from the cerebrospinal fluid and wound secretion of patient Z. PFGE analysis showed that the E. hormaechei strains (E1, E2 and E3) isolated from the patients were homologous to the strains of E. hormaechei isolated from the electric shavers (B2-E, B3-E and B4-E), and all these strains were of ST50 type and carried bla_ACT-15 and bla_CTX-M-3 genes, and that the K.pneumoniae strains (K1-K4) were also homologous to the K. pneumoniae strains isolated from the electric shavers (B2-K, B3-K and B4-K), and all these strains were of ST8 type and carried bla_SHV-164 and bla_TEM-1A genes.

CONCLUSIONS The intracranial infections that occur after endoscopic microvascular decompression for the treatment of trigeminal neuralgia are related to the preoperative use of electric shavers contaminated with E. hormaechei and K. pneumonia during skin preparation. Therefore, it is necessary to carry out the disinfection of electric shavers that are used for skin preparation and monitor the disinfection effect.