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Aseptic meningitis and hydrocephalus after posterior fossa surgery

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Summary

In an attempt to define the tissue of origin of substances causing aseptic meningitis and secondary hydrocephalus after posterior fossa surgery, analysis of several marker substances from blood, brain, tumour and muscle in the CSF was performed early in seven postoperative patients. No clear pattern emerged which could relate the substances, CSF reaction, and meningeal scarring. The effects of various factors such as contrast studies, drainage, and steroids were also not clear.

Review of the literature reveals that all four tissues can cause inflammation. Certain facts about the anatomy of the basilar cisterns and arachnoid villi probably make them logical sites for problems in CSF circulation. Children, for several reasons, are most susceptible to this complication. The complexity of factors in human cases suggests that the problem should be studied in an animal model.

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References

  1. Carmel, P. W., Fraser, R. A. R., Stein, B. M., Aseptic meningitis following posterior fossa surgery in children. J. Neurosurg.41 (1974), 44–48.

    PubMed  Google Scholar 

  2. Stehbens, W. E., Pathology of the Cerebral Blood Vessels, pp. 252–283. St. Louis: Mosby. 1972.

    Google Scholar 

  3. Meredith, J. M., The inefficiency of lumbar puncture for the removal of red blood cells from the cerebrospinal fluid. Surgery9 (1941), 524–533.

    Google Scholar 

  4. Sprong, W., The disappearance of blood from the cerebrospinal fluid in traumatic subarachnoid hemorrhage. Surg. Gynecol. Obstet.58 (1934), 705–710.

    Google Scholar 

  5. Tourtellotte, H. W., Metz, L. N., Bryan, E. R.,et al., Spontaneous subarachnoid hemorrhage. Neurology14 (1964), 301–306.

    PubMed  Google Scholar 

  6. McMenemy, W. H., The significance of subarachnoid bleeding. Proc. R. Soc. Med.47 (1954), 701–704.

    PubMed  Google Scholar 

  7. Barrows, L. J., Hunter, F. T., Banker, B. O., The nature and clinical significance of pigments in the cerebrospinal fluid. Brain78 (1955), 59–80.

    PubMed  Google Scholar 

  8. Matthews, W. F., Frommeyer, W. B., jr., The in vitro behavior of erythrocytes in human cerebrospinal fluid. J. Lab. Clin. Med.45 (1955), 508–515.

    PubMed  Google Scholar 

  9. Roost, K. T., Pimstone, N. R., Diamond, T.,et al., The formation of cerebrospinal fluid xanthochromia after subarachnoid hemorrhage. Neurology22 (1972), 973–977.

    PubMed  Google Scholar 

  10. Adams, J. E., Prawirohardjo, S., Fate of red blood cells injected into cerebrospinal fluid pathways. Neurology9 (1959), 561–564.

    Google Scholar 

  11. Dupont, J. R., Van Wart, C. A., Kraintz, L., The clearance of major components of whole blood from cerebrospinal fluid following simulated subarachnoid hemorrhage. J. Neuropathol. Exp. Neurol.20 (1961), 450–455.

    PubMed  Google Scholar 

  12. McQueen, J. D., Northrup, B. E., Leibruck, L. G., Arachnoid clearance of red blood cells. J. Neurol. Neurosurg. Psychiatry37 (1974), 1316–1321.

    PubMed  Google Scholar 

  13. Arutiunov, A. I., Baron, M. A., Majorova, N. A., The role of mechanical factors in the pathogenesis of short-term and prolonged spasm of the cerebral arteries. J. Neurosurg.40 (1974), 459–472.

    PubMed  Google Scholar 

  14. Peters, A., Palay, S. L., Webster, Hde. E., The Fine Structure of the Nervous System. The Neurons and Supporting Cells. Ch. XIII. The Meninges, pp. 332–343. Philadelphia: Saunders. 1976.

    Google Scholar 

  15. YaŞargil, M. G., Kasdaglis, K., Jain, K. K.,et al., Anatomical observations of the subarachnoid cisterns of the brain during surgery. J. Neurosurg.44 (1976), 298–302.

    PubMed  Google Scholar 

  16. Finlayson, A. I., Penfield, W., Acute postoperative aseptic leptomeningitis. AMA Arch. Neurol. Psych.46 (1941), 250–276.

    Google Scholar 

  17. Jackson, I. J., Aseptic hemogenic meningitis. AMA Arch. Neurol. Psych.62 (1949), 572–589.

    Google Scholar 

  18. Dyken, P. R., Cerebrospinal fluid cytology: practical clinical usefulness. Neurology25 (1975), 210–217.

    PubMed  Google Scholar 

  19. Oehmichen, M., Cerebrospinal Fluid Cytology. An Introduction and Atlas. Philadelphia: Saunders. 1976.

    Google Scholar 

  20. Bagley, C., Blood in the cerebrospinal fluid. Resultant Functional and Organic Alterations in the Central Nervous System. B. Clinical Data. Arch. Surg.17 (1928), 39–81.

    Google Scholar 

  21. Hammes, E. M., jr., Reaction of the meninges to blood. AMA Arch. Neurol. Psychiat.52 (1944), 505–514.

    Google Scholar 

  22. Penning, L., Front, D., Brain Scintigraphy. A Neuroradiological Approach. Amsterdam: Excerpta Medica. 1975.

    Google Scholar 

  23. Bagley, C., Blood in the cerebrospinal fluid. Resultant functional and organic alterations in the central nervous system. A. Experimental data. Arch. Surg.17 (1928), 18–38.

    Google Scholar 

  24. Browder, J., Kaplan, H. A., Cerebral Dural Sinuses and Their Tributaries. Ch. 5. Lateral Lacunae, pp. 57–68. Springfield, Ill.: Ch. C Thomas. 1976.

    Google Scholar 

  25. Tripathi, B. J., Tripathi, R. C., Vacuolar transcellular channels as a drainage pathway for cerebrospinal fluid. J. Physiol.239 (1974), 195–206.

    PubMed  Google Scholar 

  26. James, A. E., jr., McComb, J. G., Christian, J.,et al., The effect of cerebrospinal fluid pressure on the size of drainage pathways. Neurology26 (1976), 659–663.

    PubMed  Google Scholar 

  27. Welch, K., The principles of physiology of the cerebrospinal fluid in relation to hydrocephalus including normal pressure hydrocephalus. In Friedlander, W. J. (ed.): Advances in Neurology, Vol. 13, pp. 247–332. New York: Raven. 1975.

    Google Scholar 

  28. Ellington, E., Margolis, G., Block of arachnoid villus by subarachnoid hemorrhage. J. Neurosurg.30 (1969), 651–657.

    PubMed  Google Scholar 

  29. McQueen, J. D., Northrup, B. E., Leibroch, L. G.,et al., The sealing action of subarachnoid blood. Acta Neurol. Lat. Am.17 Suppl. (1972), 89–98.

    Google Scholar 

  30. Alksne, J. F., Lovings, E. T., The role of the arachnoid villus in the removal of red blood cells from the subarachnoid space. An electron microscope study in the dog. J. Neurosurg.36 (1972), 192–200.

    PubMed  Google Scholar 

  31. Kurokawa, K., Dunsker, S., Mayfield, F. H., Spinal dural patch grafts in experimental animals. J. Neurol. Neurosurg. Psychiatry38 (1975), 412.

    Google Scholar 

  32. Kagan, L. J., Myoglobin: Biochemical, Physiological, and Clinical Aspects. New York: Columbia. 1973.

  33. Woods, A. H., Personal communication.

  34. Bernat, J. L., Glioblastoma multiforme and the meningial syndrome. Neurology26 (1976), 1071–1074.

    PubMed  Google Scholar 

  35. Shabo, A. L., Abbott, M. M., Maxwell, D. S., The response of the arachnoid villus to an intracisternal injection of autogenous brain tissue. An electron microscopic study in the macaque monkey. Neurology19 (1969), 724–734.

    PubMed  Google Scholar 

  36. Greenblatt, S. H., Cerebrospinal fluid creatine phosphokinase in acute subarachnoid hemorrhage. J. Neurosurg.44 (1976), 50–54.

    PubMed  Google Scholar 

  37. Hershkowitz, N., Cumings, J. N., Creatine kinase in cerebrospinal fluid. J. Neurol. Neurosurg. Psychiatry27 (1964), 247–250.

    PubMed  Google Scholar 

  38. Sherwin, A. L., Norris, J. W., Bulcke, J. A., Spinal fluid creatine kinase in neurologic disease. Neurology19 (1969), 993–999.

    PubMed  Google Scholar 

  39. Somer, H., Kaste, M., Troupp, H.,et al., Brain creatine kinase in blood after acute brain injury. J. Neurol. Neurosurg. Psychiatry38 (1975), 572–576.

    PubMed  Google Scholar 

  40. Kaste, M., Somer, H., Konttinen, A., Brain-type creatine kinase isoenzyme. Occurrence in serum in acute cerebral disorders. Arch. Neurol.34 (1977), 142–144.

    PubMed  Google Scholar 

  41. Wolintz, A. H., Jacobs, L. D., Christoff, N.,et al., Serum and cerebrospinal fluid enzymes in cerebrovascular disease. Creatine phosphokinase, aldolase, and lactic dehydrogenase. Arch. Neurol.20 (1969), 54–61.

    PubMed  Google Scholar 

  42. Cushing, H., Experiences with the cerebellar medulloblastomas. Acta Pathol. Microbiol. Scand.7 (1930), 1–86.

    Google Scholar 

  43. Cushing, H., Experiences with the cerebellar astrocytomas. Surg. Gynecol. Obstet.52 (1931), 129–204.

    Google Scholar 

  44. Cushing, H., Bailey, P., Tumors Arising from the Blood Vessels of the Brain. Angiomatous Malformations and Hemangioblastomas. Springfield, Ill.: Ch. C Thomas. 1928.

    Google Scholar 

  45. Jacobs, G. B., Klemme, W. M., Murphree, H. C., Aseptic meningitis and pseudomeningocoel formation as a complication of surgery in the posterior fossa. Pac. Med. Surg.74 (1955), 320–324.

    Google Scholar 

  46. Matson, D. D., Neurosurgery of Infancy and Childhood. 2nd Ed. p. 435. Springfield, Ill.: Ch. C Thomas. 1969.

    Google Scholar 

  47. McLaurin, R. L., Ford, L. E., Obstruction following posterior fossa surgery: the postoperative Dandy Walker syndrome. Johns Hopkins Med. J.122 (1968), 309–318.

    PubMed  Google Scholar 

  48. Scatliff, J. H., Kummes, A. J., Frankel, S. A.,et al., Cystic enlargement and obstruction of the fourth ventricle following posterior fossa surgery. The postoperative Dandy Walker syndrome. Amer. J. Roentgenol. Radium Ther. Nucl. Med.88 (1962), 536–542.

    Google Scholar 

  49. Stein, B. M., Tenner, M. S., Fraser, R. A. R., Hydrocephalus following removal of cerebellar astrocytomas in children. J. Neurosurg.36 (1972), 763–768.

    PubMed  Google Scholar 

  50. Stein, B. M., Fraser, R. A. R., Tenner, M. S., Normal pressure hydrocephalus: Complication of posterior fossa surgery in children. Pediatrics49 (1972), 50–58.

    PubMed  Google Scholar 

  51. Ojemann, R. G., Normal pressure hydrocephalus. Clin. Neurosurg.19 (1971), 337–376.

    Google Scholar 

  52. Udvarhelyi, G. B., Wood, J. H., James, A. E., jr.,et al., Results and complications in 55 shunted patients with normal pressure hydrocephalus. Surg. Neurol.3 (1975), 271–275.

    PubMed  Google Scholar 

  53. Cronquist, S., Encephalographic changes following subarchnoid haemorrhage. Brit. J. Radiol.40 (1967), 38–42.

    PubMed  Google Scholar 

  54. Hill, M. E., Lougheed, W. M., Barnett, H. J. M., A treatable form of dementia due to normal-pressure communicating hydrocephalus. Can. Med. Assoc. J.97 (1967), 1309–1320.

    PubMed  Google Scholar 

  55. Kibler, R. F., Couch, R. S. C., Crompton, M. R., Hydrocephalus in the adult following spontaneous subarachnoid haemorrhage. Brain84 (1961), 45–60.

    PubMed  Google Scholar 

  56. Askenazy, H. M., Herzberger, E. E., Wijsenbeck, H. S., Hydrocephalus with vascular malformations of the brain. A preliminary report. Neurology3 (1953), 213–220.

    PubMed  Google Scholar 

  57. Barnett, H. J. M., Some clinical features of intracranial aneurysms. Clin. Neurosurg.16 (1969), 43–72.

    PubMed  Google Scholar 

  58. Foltz, E. L., Ward, A. A., jr., Communicating hydrocephalus from subarachnoid bleeding. J. Neurosurg.13 (1956), 546–566.

    PubMed  Google Scholar 

  59. Fox, J. L., Luessenhop, A. J., Hydrocephalus secondary to hemorrhage from a basilar artery aneurysm. With a note on embolization technique. Acta Neurochir. (Wien)17 (1967), 228–235.

    Google Scholar 

  60. Front, D., Penning, L., Angiographic assessment of ventricular enlargement in subarachnoid haemorrhage. J. Neurol. Sci.13 (1971), 1–11.

    PubMed  Google Scholar 

  61. Gallera, R., Greitz, T., Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J. Neurosurg.32 (1970), 634–641.

    PubMed  Google Scholar 

  62. Hayward, R. D., Intracranial arteriovenous malformations. Observations after experience with computerized tomography. J. Neurol. Neurosurg. Psychiatry39 (1976), 1027–1033.

    PubMed  Google Scholar 

  63. Knibestöl, M., Karadayi, A., Tovi, D., Echo-encephalographic study of ventricular dilatation after subarachnoid hemorrhage with special reference to the effect of antifibrinolytic treatment. Acta Neurol. Scand.54 (1976), 57–70.

    PubMed  Google Scholar 

  64. Shulman, K., Martin, B. F., Popoff, N.,et al., Recognition and treatment of hydrocephalus following spontaneous subarachnoid hemorrhage. J. Neurosurg.20 (1963), 1040–1049.

    PubMed  Google Scholar 

  65. Strain, R. E., Progressive communicating hydrocephalus following subarachnoid bleeding—a neurosurgical emergency. South Med. J.56 (1963), 613–618.

    PubMed  Google Scholar 

  66. Sweet, W. H., Seeping intracranial aneurysm simulating neoplasm. AMA Arch. Neurol. Psych.45 (1941), 86–104.

    Google Scholar 

  67. Sypert, G. W., Leffman, H., Ojeman, G. A., Adult normal pressure hydrocephalus manifested by Parkinson-dementia complex. Neurology23 (1973), 234–238.

    PubMed  Google Scholar 

  68. Theander, S., Granholm, L., Sequelae after spontaneous subarachnoid haemorrhage, with special reference to hydrocephalus and Korsakoff's syndrome Acta Neurol. Scand.43 (1967), 479–488.

    PubMed  Google Scholar 

  69. Tomlinson, B. E., Brain changes in ruptured intracranial aneurysm. J. Clin. Pathol.12 (1959), 391–399.

    PubMed  Google Scholar 

  70. Lewin, W., Preliminary observations on external hydrocephalus after severe head injury. Brit. J. Surg.55 (1969), 747–751.

    Google Scholar 

  71. Penfield, W., Cone, W., Elementary principles of the treatment of head injuries. Can. Med. Assoc. J.48 (1943), 99–104.

    Google Scholar 

  72. Granholm, L., Radberg, C., Congenital communicating hydrocephalus. J. Neurosurg.20 (1963), 338–343.

    PubMed  Google Scholar 

  73. Guidetti, B., Giuffrè, R., Palma, L.,et al., Hydrocephalus in infancy and childhood. Our experience of CSF shunting. Child's Brain2 (1976), 209–225.

    PubMed  Google Scholar 

  74. Larroche, J. C., Post-haemorrhagic hydrocephalus in infancy. Biol. Neonate20 (1972), 287–299.

    PubMed  Google Scholar 

  75. Lorber, J., Post-haemorrhagic hydrocephalus. Dev. Med. Child Neurol.16 (Suppl 32) (1974), 157–159.

    Google Scholar 

  76. Deonna, T., Payot, M., Probst, A.,et al., Neonatal intracranial hemorrhage in premature infants. Pediatrics56 (1975), 1056–1064.

    PubMed  Google Scholar 

  77. Lourie, H., Berne, A., A contribution on the etiology and pathogenesis of congenital communicating hydrocephalus. Neurology15 (1965), 815–822.

    PubMed  Google Scholar 

  78. Wise, B. L., Ballard, R., Hydrocephalus secondary to intracranial hemorrhage in premature infants. Child's Brain2 (1976), 234–241.

    PubMed  Google Scholar 

  79. Goldstein, G. W., Chaplin, E. R., Maitland, J.,et al., Transient hydrocephalus in premature infants: treatment by lumbar punctures. Lancet1 (1976), 512–514.

    Google Scholar 

  80. Bradford, F. K., Sharkey, P. C., Physiologic effects from the introduction of blood and other substances into the subarchnoid space of dogs. J. Neurosurg.19 (1962), 1017–1022.

    PubMed  Google Scholar 

  81. McQueen, J. D., Jelsma, L. F., Intracranial hypertension. Cerebrospinal fluid pressure rises following intracisternal infusions of blood components in dogs. Arch. Neurol.16 (1967), 501–508.

    PubMed  Google Scholar 

  82. Sachs, E., jr., Diagnosis and Treatment of Brain Tumours and Care of the Neurosurgical Patient, pp. 518–520. St. Louis: Mosby. 1949.

    Google Scholar 

  83. Kennady, J. C., Investigations of the early fate and removal of subarachnoid blood. Pac. Med. Surg.75 (1967), 163–168.

    PubMed  Google Scholar 

  84. Greitz, T., Grepe, A., Encephalography in the diagnosis of convexity block hydrocephalus. Acta Radiol. (Diagn.)11 (1971), 232–242.

    Google Scholar 

  85. Frigeni, G., Gaini, S. M., Paoletti, P.,et al., Isotope cisternography. Consideration on abnormal pictures. Acta Neurochir. (Wien)25 (1971), 145–163.

    Google Scholar 

  86. Frigeni, G., Gaini, S. M., Paoletti, P.,et al., Study of possible postsurgical complications in neurosurgery using radioisotope cisternography. In Harbert, J. C. (ed.), Cisternography and Hydrocephalus, pp. 303–316. Springfield, Ill.: Ch. C Thomas. 1972.

    Google Scholar 

  87. Rudd, T. G., O'Neal, J. T., Nelp, W. B., Cerebrospinal fluid circulation following subarachnoid hemorrhage. J. Nucl. Med.12 (1971), 61–63.

    PubMed  Google Scholar 

  88. Williams, J. P., Lynde, R. H., Pribram, H. F. W., Cisternographic changes following subarachnoid hemorrhage. In Harbert, J. C. (ed.), Cisternography and Hydrocephalus, pp. 285–291. Springfield, Ill.: Ch. C Thomas. 1972.

    Google Scholar 

  89. Cowan, R. J., Maynard, C. D., Trauma to the brain and extracranial structures. Semin. Nucl. Med.4 (1974), 319–338.

    PubMed  Google Scholar 

  90. Front, D., Beks, J. W. F., Georganas, C. L.,et al., Abnormal patterns of cerebrospinal fluid flow and absorption after head injuries: Diagnosis by isotope cisternography. Neuroradiology4 (1972), 6–13.

    PubMed  Google Scholar 

  91. Enzmann, D. R., Norman, D., Mani, J.,et al., Computed tomography of granulomatous basal arachnoiditis. Radiology120 (1976), 341–344.

    PubMed  Google Scholar 

  92. Greitz, T., Hindmarsh, T., Computer assisted tomography of intracranial CSF circulation using a water-soluble contrast medium. Acta Radiol. (Diagn.)15 (1974), 497–507.

    Google Scholar 

  93. Hindmarsh, T., Elimination of water-soluble contrast media from the subarachnoid space. Investigation with computer tomography. Acta Radiol., Suppl.346 (1975), 45–49.

    Google Scholar 

  94. Roberson, G. H., Brismar, J., Weiss, A.,et al., CSF enhancement for computerized tomography. Surg. Neurol.6 (1976), 235–238.

    PubMed  Google Scholar 

  95. Hindmarsh, T., Greitz, T., Computer cisternography in the diagnosis of communicating hydrocephalus. Acta Radiol., Suppl.346 (1975), 91–97.

    Google Scholar 

  96. Carmel, P. W., Fraser, R. A. R., Stein, B. M., Aseptic meningitis linked to brain surgery. JAMA220 (1972), 1554.

    Google Scholar 

  97. Lorber, J., Bhat, U. S., Posthaemorrhagic hydrocephalus. Diagnosis, differential diagnosis, treatment and long-term results. Arch. Dis. Child49 (1974), 751–762.

    PubMed  Google Scholar 

  98. Harbert, J. C., Radionuclide cisternography. Semin. Nucl. Med.1 (1971), 90–106.

    Google Scholar 

  99. Tyson, J. E., Gilmartin, R. C., jr., Friedman, B. I.,et al., 131I HAS cisternography in children with meningitis. In Harbert, J. C. (ed.): Cisternography in Hydrocephalus, pp. 413–432. Springfield, Ill.: Ch. C Thomas. 1972.

    Google Scholar 

  100. Turner, L., Structure of arachnoid granulations with observations on their physiological and pathological significance. Ann. R. Coll. Surg. Eng.29 (1961), 237–264.

    Google Scholar 

  101. Clark, W. E. Le G., On the Pacchionian bodies. J. Anat.55 (1920), 40–48.

    Google Scholar 

  102. Gilles, F. H., Davidson, R. I., Communicating hydrocephalus associated with deficient dysplastic parasagittal arachnoidal granulations. J. Neurosurg.35 (1971), 421–426.

    PubMed  Google Scholar 

  103. Madden, J. W., Personal communication.

  104. GyllenswÄrd, A., Malmstrom, S., The cerebrospinal fluid in immature infants. Acta Paediatr. Scand.51 (Suppl. 135) (1962), 54–62.

    Google Scholar 

  105. Naidoo, B. T., The cerebrospinal fluid in the healthy newborn infant. S. Afr. Med. J.42 (1968), 933–935.

    PubMed  Google Scholar 

  106. Wolf, H., Hoepffner, L., The cerebrospinal fluid in the newborn and premature infant. World Neurology28 (1961), 871–877.

    Google Scholar 

  107. Howland, W. J., Curry, J. L., Pantopaque arachnoiditis. Experimental study of blood as a potentiating agent and corticosteroids as an ameliorating agent. Acta Radiol. (Diagn.), Suppl.5 (1966), 1032–1041.

    Google Scholar 

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  1. H. H. Kaufman M.D. (Assistant Professor)

    Present address: Division of Neurosurgery, The University of Texas Medical School at Houston, John W. Freeman Building, 6400 West Cullen, 77030, Houston, TX, USA

  2. P. W. Carmel (Associate Professor)

    Present address: Department of Neurosurgery, Columbia Presbyterian Medical Center, West 168 Street, 10032, New York, NY, USA

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    Kaufman, H.H., Carmel, P.W. Aseptic meningitis and hydrocephalus after posterior fossa surgery. Acta neurochir 44, 179–196 (1978). https://doi.org/10.1007/BF01402060

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