Infection

, Volume 45, Issue 6, pp 841–848 | Cite as

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

  • Pasquale Pagliano
  • Chiara Caggiano
  • Tiziana Ascione
  • Domenico Solari
  • Giusy Di Flumeri
  • Luigi Maria Cavallo
  • Fabio Tortora
  • Paolo Cappabianca
Original Paper
First Online:
Received:
Accepted:

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.

Keywords

Meningitis Transsphenoidal endoscopic surgery Antibiotic treatment Prophylaxis Nosocomial infection Neurosurgery 
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Notes

Compliance with ethical standards

Conflict of interest

None.

Ethical approval

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

Informed consent

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

Funding

No funding was received for this study.

Transparency declarations

None to declare.

Supplementary material

15010_2017_1056_MOESM1_ESM.xls (49 kb)
Supplementary material 1 (XLS 49 kb)

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Infectious DiseasesD. Cotugno HospitalNaplesItaly
  2. 2.Division of Neurosurgery, School of Medicine and SurgeryUniversità degli Studi di Napoli Federico IINaplesItaly
  3. 3.Centro Traumatologico Ortopedico, Second University of Naples, Dipartimento Medico-Chirurgico di Internistica Clinica e Sperimentale “F. Magrassi e A. Lanzara”NaplesItaly

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