Pagliano P, et al. – The purpose of this work was to assess the characteristics of meningitis after endoscopic endonasal transsphenoidal surgery (EETS) comparing the findings retrieved to those highlighted by literature search. Despite endoscope went through non–sterile structures, the incidence of meningitis after EETS was low; microorganisms retrieved were those present within sinus microenvironment. Authors recommended suspecting meningitis in patients with persistent fever and impaired conscience status after EETS.

Methods

• Authors evaluated patients treated by EETS during an 18–year period in the Department of Neurosurgery of ‘Federico II’ University of Naples, and included them in the study if they fulfilled criteria for meningitis.
• Evaluation of epidemiological, demographic, laboratory, and microbiological findings was performed.
• The study was completed with a literature research in accordance to PRISMA methodology.

Results

• 1450 patients underwent EETS, 8 of them (0.6%) had meningitis [median age 46 years (range 33–73)].
• Patients underwent endoscopic surgery 1–15 days (median 4 days) before diagnosis.
• In these patients, meningeal signs were always present.
• CSF examination indicated elevated cells [median 501 cells/μL (range 30–5728)], high protein [median 445 mg/dL (range 230–1210)], and low glucose [median 10 mg/dL (range 1–39)].
• CSF culture indicated Gram–negative bacteria in four cases (Klebsiella pneumoniae, Escherichia coli, Alcaligenes spp., and Haemophilus influenzae), Streptococcus pneumoniae in two cases,
• In one case ,CSF culture revealed Aspergillus fumigatus .
• Two cases had an abscess occupying the surgical site.
• Favorable outcome was achieved in six cases; two patients died.
• The literature search indicated that incidence of meningitis approached to 2%.