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Characteristics of meningitis following transsphenoidal endoscopic surgery: a case series and a systematic literature review

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Abstract

Background

Meningitis occurs in 0.8–1.5% of patients undergoing neurosurgery. The aim of the study was to evaluate the characteristics of meningitis after endoscopic endonasal transsphenoidal surgery (EETS) comparing the findings retrieved to those highlighted by literature search.

Materials and methods

Patients treated by EETS during an 18-year period in the Department of Neurosurgery of ‘Federico II’ University of Naples were evaluated and included in the study if they fulfilled criteria for meningitis. Epidemiological, demographic, laboratory, and microbiological findings were evaluated. A literature research according to PRISMA methodology completed the study.

Results

EETS was performed on 1450 patients, 8 of them (0.6%) had meningitis [median age 46 years (range 33–73)]. Endoscopic surgery was performed 1–15 days (median 4 days) before diagnosis. Meningeal signs were always present. CSF examination revealed elevated cells [median 501 cells/μL (range 30–5728)], high protein [median 445 mg/dL (range 230–1210)], and low glucose [median 10 mg/dL (range 1–39)]. CSF culture revealed Gram-negative bacteria in four cases (Klebsiella pneumoniae, Escherichia coli, Alcaligenes spp., and Haemophilus influenzae), Streptococcus pneumoniae in two cases, Aspergillus fumigatus in one case. An abscess occupying the surgical site was observed in two cases. Six cases reported a favorable outcome; two died. Incidence of meningitis approached to 2%, as assessed by the literature search.

Conclusions

Incidence of meningitis after EETS is low despite endoscope goes through non-sterile structures; microorganisms retrieved are those present within sinus microenvironment. Meningitis must be suspected in patients with persistent fever and impaired conscience status after EETS.

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Authors and Affiliations

  1. Department of Infectious Diseases, D. Cotugno Hospital, AORN dei Colli, Naples, Italy

    Pasquale Pagliano, Tiziana Ascione & Giusy Di Flumeri

  2. Division of Neurosurgery, School of Medicine and Surgery, Università degli Studi di Napoli Federico II, Naples, Italy

    Chiara Caggiano, Domenico Solari, Luigi Maria Cavallo & Paolo Cappabianca

  3. Centro Traumatologico Ortopedico, Second University of Naples, Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale “F. Magrassi e A. Lanzara”, Naples, Italy

    Fabio Tortora

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  1. Pasquale Pagliano
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Correspondence to Pasquale Pagliano.

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Internal review board judged the project of the study and the final title of the paper compliant with ethical standards.

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Each patient signed an informed consent before surgical procedure and when he was admitted to the Unit of Infectious Diseases.

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No funding was received for this study.

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Pagliano, P., Caggiano, C., Ascione, T. et al. Characteristics of meningitis following transsphenoidal endoscopic surgery: a case series and a systematic literature review. Infection 45, 841–848 (2017). https://doi.org/10.1007/s15010-017-1056-6

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  • DOI: https://doi.org/10.1007/s15010-017-1056-6

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