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Delayed intracranial abscess after acoustic neuroma surgery: a report of two cases
H Staecker1, J B Nadol, R Ojeman
1Department of Otology and Neurotology, Harvard Medical School and Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
Objective:
The use of antibiotics before and after surgery has made infectious complications of neurotologic surgery rare. The neurosurgical literature cites a rate of postoperative meningitis between 1% and 2% for "clean" cases and 1.5% to 2.5% for "clean contaminated" cases, such as cerebrospinal fluid contact with the middle ear or mastoid. Reports of infections after neurotologic procedures are rare in the otologic literature. In this report, two patients with brain abscess occurring in a delayed fashion after surgery are described.
Study Design:
The study design was a retrospective chart review and case report.
Setting:
The study was conducted at a tertiary referral center.
Results:
Patient 1 underwent a suboccipital craniotomy for removal of an acoustic neuroma and had an uneventful postoperative recovery. Three months after surgery, he reported mild unsteadiness. Examination revealed mild ataxia, which led to repeat magnetic resonance imaging (MRI) and a diagnosis of cerebellar abscess. Patient 2 underwent translabyrinthine removal of an acoustic neuroma complicated by postoperative Pseudomonas aeruginosa meningitis, which responded promptly to intravenous antibiotics. Fifteen months after surgery, he visited a neurologist after having a seizure and was treated with anticonvulsants. After a second episode of seizure, imaging studies showed a temporal lobe abscess.
Conclusions:
The signs of intracranial abscess may be subtle and can occur weeks or months after surgery, requiring vigilance and a high index of suspicion for diagnosis. A change in postoperative symptoms after acoustic neuroma surgery should signal further investigation using MRI with gadolinium.
Insights
Delayed brain abscesses can occur months after neurotologic surgery. Vigilance for subtle symptoms and MRI with gadolinium are crucial for early diagnosis of these rare infectious complications.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Neurology
Background:
- Infectious complications of neurotologic surgery are rare due to antibiotic prophylaxis.
- Postoperative meningitis rates range from 1-2.5% in neurosurgical literature.
- Delayed infections after otologic procedures are infrequently reported.
Observation:
- Two cases of delayed brain abscess after acoustic neuroma surgery are presented.
- Patient 1 developed a cerebellar abscess 3 months post-craniotomy.
- Patient 2 developed a temporal lobe abscess 15 months after surgery for meningitis.
Findings:
- Subtle signs of intracranial abscess can manifest weeks or months post-surgery.
- Delayed abscesses require a high index of suspicion for diagnosis.
- Magnetic resonance imaging (MRI) with gadolinium is essential for detecting these complications.
Implications:
- Neurotologic surgeons must maintain vigilance for delayed intracranial infections.
- Any change in postoperative symptoms warrants further investigation with MRI.
- Prompt diagnosis and treatment are critical for favorable outcomes in delayed brain abscess cases.