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Clinical characteristics of streptococcus pneumoniae meningoencephalitis after transsphenoidal surgery: three case

Nobuyuki Kobayashi1, Noriaki Fukuhara, Takahito Fukui

  • 1Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital.

Neurologia Medico-Chirurgica
|January 15, 2014
PubMed

Insights

Three rare cases of Streptococcus pneumoniae meningoencephalitis (SPM) occurred after trans-sphenoidal surgery (TSS). These severe infections developed suddenly 1-2 months post-op, indicating a need for prompt emergency treatment.

Area of Science:

  • Neurosurgery
  • Infectious Diseases
  • Neurology

Background:

  • Trans-sphenoidal surgery (TSS) is a common neurosurgical approach.
  • Postoperative meningitis is a known but rare complication of TSS.
  • Streptococcus pneumoniae meningoencephalitis (SPM) is an extremely rare post-TSS complication.

Observation:

  • Three cases of severe SPM occurred in 1,965 TSS procedures (0.15%) between 2004-2010.
  • Patients presented with sudden severe clinical events 1-2 months postoperatively.
  • No history of sinusitis or pneumonia, and no rhinorrhea were noted in these patients.
  • Residual neurological sequelae were observed despite intensive care.

Findings:

  • SPM can manifest suddenly within 2 months after TSS, even without cerebrospinal fluid (CSF) leakage.
  • Bacterial cultures of sphenoidal sinus mucous membranes (BCSM) obtained during surgery were not predictive of SPM in two cases.
  • Reduced resistance to infection may be a contributing factor.

Implications:

  • Severe postoperative SPM requires emergency treatment.
  • BCSM is not a reliable predictor for postoperative meningitis after TSS.
  • Clinicians should maintain a high index of suspicion for SPM in patients presenting with neurological decline post-TSS.

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