Intracranial Microbiome and Postoperative Outcomes in Neurosurgery: A Systematic Review

Abstract

This study aimed to analyze, through a systematic review of the literature, the association between the microbiome and postoperative outcomes in patients undergoing neurosurgical procedures. This is a descriptive and analytical review conducted through searches in PubMed/MEDLINE, Scopus, Web of Science, and Embase databases, using descriptors related to microbiome, gut–brain axis, neurosurgery, and clinical outcomes. Original full-text studies evaluating pathophysiological, immunological, and clinical aspects of the interaction between microbiota and the central nervous system were included. The results demonstrated that microbiome alterations, particularly perioperative gut dysbiosis, are associated with increased neuroinflammation, a higher risk of postoperative cognitive dysfunction, and a greater incidence of infectious complications. Factors such as antibiotic use, anesthesia, and surgical stress were shown to significantly influence microbiota composition, negatively impacting neurological recovery. Additionally, interventions such as probiotics and other microbiome-targeted therapies showed potential in improving clinical outcomes. In conclusion, the microbiome represents an important modulator of neurosurgical outcomes and a promising target for therapeutic interventions. However, robust clinical studies are still needed to better understand its mechanisms and clinical applicability.