J Neurol Surg Rep 2016; 77(04): e151-e155
DOI: 10.1055/s-0036-1593470
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Aseptic Meningitis with Craniopharyngioma Resection: Consideration after Endoscopic Surgery

Jenny X. Chen
1   Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
,
Blake C. Alkire
1   Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
,
Allen C. Lam
1   Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
,
William T. Curry*
3   Department of Surgery (Neurosurgery), Harvard Medical School, Boston, Massachusetts, United States
,
Eric H. Holbrook*
1   Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, United States
2   Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

19 January 2016

29 August 2016

Publication Date:
06 October 2016 (online)

Abstract

Objectives While bacterial meningitis is a concerning complication after endoscopic skull base surgery, the diagnosis can be made without consideration for aseptic meningitis. This article aims to (1) present a patient with recurrent craniopharyngioma and multiple postoperative episodes of aseptic meningitis and (2) discuss the diagnosis and management of aseptic meningitis.

Design Case report and literature review.

Results A 65-year-old female patient with a symptomatic craniopharyngioma underwent transsphenoidal resection. She returned postoperatively with symptoms concerning for cerebrospinal fluid (CSF) leak and bacterial meningitis. Lumbar puncture demonstrated mildly elevated leukocytes with normal glucose levels. Cultures were sterile and she was discharged on antibiotics. She returned 18 days postoperatively with altered mental status and fever. Again, negative CSF cultures suggested aseptic meningitis. Radiological and intraoperative findings were now concerning for widespread cerebrovascular vasospasm due to leaked craniopharyngioma fluids. In the following months, her craniopharyngioma recurred and required multiple surgical resections. Days after her last operation, she returned with mental status changes and a sterile CSF culture. She was diagnosed with recurrent aseptic meningitis and antibiotics were discontinued. The patient experienced near complete resolution of symptoms.

Conclusions Consideration of aseptic meningitis following craniopharyngioma resection is critical to avoid unnecessary surgical re-exploration and prolonged courses of antibiotics.

* These authors contributed equally to this work and are cosenior authors.