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Meningitis after trans-sphenoidal excision of pituitary tumours
W R Gransden1, M Wickstead, S J Eykyn
1Department of Microbiology, St. Thomas's Hospital Medical School, London.
Abstract:
Between 1974 and 1986, eleven of 114 patients undergoing trans-sphenoidal removal of pituitary tumours developed meningitis despite prophylaxis, usually with chloramphenicol. Nine patients had cerebrospinal fluid rhinorrhoea and one died. A variety of pathogens was isolated, including enterobacteria, and four of the eleven were resistant to the antibiotics given as prophylaxis. Enterobacterial meningitis was always associated with infection of the sphenoidal sinus involving the muscle graft or nasal pack (five cases), and removal of the muscle graft was necessary in three cases despite the use of appropriate antibiotics.
Insights
Trans-sphenoidal surgery for pituitary tumors can lead to meningitis, even with antibiotic prophylaxis. Sphenoid sinus infection, particularly with enterobacteria, is a significant risk factor requiring intervention.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Otolaryngology
Background:
- Trans-sphenoidal surgery is a common procedure for pituitary tumor removal.
- Meningitis is a serious potential complication following this surgery.
- Antibiotic prophylaxis is standard practice to prevent infections.
Purpose of the Study:
- To investigate the incidence and characteristics of meningitis after trans-sphenoidal pituitary tumor surgery.
- To identify risk factors and causative pathogens associated with post-operative meningitis.
- To evaluate the effectiveness of prophylactic antibiotics and treatment strategies.
Main Methods:
- Retrospective analysis of 114 patients undergoing trans-sphenoidal pituitary tumor removal between 1974 and 1986.
- Review of patient records, including development of meningitis, causative pathogens, and treatment outcomes.
- Correlation of meningitis cases with factors such as cerebrospinal fluid (CSF) rhinorrhoea and sphenoid sinus involvement.
Main Results:
- Eleven out of 114 patients (9.6%) developed meningitis despite antibiotic prophylaxis (primarily chloramphenicol).
- Nine patients experienced cerebrospinal fluid (CSF) rhinorrhoea; one patient died.
- Enterobacteria were common pathogens, with four cases showing antibiotic resistance. Sphenoid sinus infection was linked to five meningitis cases.
Conclusions:
- Meningitis remains a significant risk after trans-sphenoidal surgery, necessitating vigilant monitoring.
- Antibiotic resistance and sphenoid sinus involvement are critical factors in post-operative meningitis.
- Surgical intervention, such as muscle graft removal, may be required for refractory infections.