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Aseptic meningitis after posterior fossa surgery treated by pseudomeningocele closure
C E Hillier1, A P Stevens, F Thomas
1Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF4 4XW, UK. hillier@cdsc.wales.nhs.uk
Abstract:
Aseptic meningitis is a recognised complication after posterior fossa surgery. It is often self limiting but occasionally runs a protracted course requiring repeated CSF examination to exclude infection, and treatment with systemic steroids. A patient is described with aseptic meningitis after posterior fossa surgery who underwent posterior fossa re-exploration nearly 3 years after the initial operation. This disclosed a pseudomeningocele, which was closed. The patient remains symptom free almost 2 years after closure. In this case of chronic aseptic meningitis after posterior fossa surgery, closure of the pseudomeningocele found at exploratory surgery led to resolution of the symptoms.
Insights
Aseptic meningitis after posterior fossa surgery can be prolonged. In a rare case, closing a pseudomeningocele nearly 3 years later resolved chronic symptoms, offering a new treatment approach.
Area of Science:
- Neurosurgery
- Neurology
- Cerebrospinal Fluid Dynamics
Background:
- Aseptic meningitis is a known complication following posterior fossa surgery.
- While often self-limiting, it can occasionally lead to prolonged symptoms requiring extensive investigation and treatment.
- Chronic aseptic meningitis necessitates careful evaluation to rule out infectious causes and manage persistent inflammation.
Observation:
- A patient presented with chronic aseptic meningitis symptoms persisting for nearly 3 years after initial posterior fossa surgery.
- Diagnostic challenges included differentiating aseptic meningitis from infection, necessitating repeated cerebrospinal fluid (CSF) examinations.
- The patient underwent a posterior fossa re-exploration due to the intractable nature of the symptoms.
Findings:
- Exploratory surgery revealed a previously undiagnosed pseudomeningocele.
- Surgical closure of the pseudomeningocele was performed.
- The patient experienced complete resolution of aseptic meningitis symptoms post-operatively.
Implications:
- This case highlights pseudomeningocele as a potential, albeit rare, cause of chronic aseptic meningitis after posterior fossa surgery.
- Surgical intervention, specifically pseudomeningocele closure, can be an effective treatment for refractory cases.
- Identifying and addressing occult CSF leaks, such as pseudomeningoceles, is crucial for managing complex post-surgical meningitis.