Meningitis after transsphenoidal pituitary adenoma surgery

Background. Endoscopic endonasal surgery is currently the approach of choice for the resection of greater than 95 % of pituitary adenomas. In transnasal transsphenoidal surgery, one of the most common complications is nosocomial meningitis.

Aim. Аnalysis of the structure and causes of meningitis in patients after transnasal adenomyotomy.

Materials and methods. The study included 3497 patients with pituitary adenomas who underwent endoscopic transsphenoidal tumor resection. Surgical treatment of all patients was carried out at the N.N. Burdenko National Medical Research Center of Neurosurgery. Patients who were diagnosed with meningitis during the in-hospital the postoperative period were analyzed.

Results. Postoperative meningitis was diagnosed in 39 (1.12 %) patients. Among patients with meningitis, 6 (15 %) patients died. The causative pathogenic agent was identified in 20 (51 %) of 39 patients. Statistically significant risk factors for the development of postoperative meningitis in patients who underwent surgery included the usage of the lumbar drain, intra- and postoperative cerebrospinal fluid leakage, and the presence of mental disorders (dementia and psychosis). Among re-operated patients, meningitis was statistically more likely to occur in patients with intraoperative and postoperative cerebrospinal fluid leakage, as well as in patients older than 60 years old. A statistically significant relationship was observed between postoperative meningitis and death.

Conclusion. Nosocomial meningitis is one of the most serious and potentially fatal complications in transsphenoidal surgery. Intraand postoperative nasal cerebrospinal fluid, along with the presence of lumbar drainage, the duration of the operation of more than 2 hours remain the main factors affecting the incidence of meningitis. 

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