Клініко-діагностичні та лікувально-профілактичні особливості синдрому асептичного менінгіту у хворих з кістозними менінгіомами головного мозку

Abstract

Objective – to investigate the frequency of aseptic meningitis syndrome (AMS), to describe the peculiarities of diagnostics, clinical signs of AMS and its differential diagnostic criteria, as well as features of immune parameters for patients with cystic meningiomas with normal postoperation recovery and with AMS progression. Materials and methods. To describe the symptoms and determine the frequency of AMS there had been analyzed the medical records of 54 patients with cystic meningiomas of various localization and histological structure, being operated at Extracerebral Tumor Department of the SI Romodanov Neurosurgery Institute NAMS of Ukraine during 2012-2016. Immunity was estimated for 18 patients with brain tumors of different histostructures and postoperative AMS (meningiomas – in 13, gliomas of low degree anaplasia – in 2, gliomas of high degree anaplasia – in 3) in comparison with normal postoperative recovery for 7 patients with tumors of the brain without occuring of AMS (meningiomas – in 3, glioblastoma – in 1, metastasis of cancer – in 1). Studies were conducted in dynamics (weekly): at the 1st-7th, 8th-14th and 15th day or further after the surgery. The phenotype of peripheral blood lymphocytes (CD3+, CD4+, CD8+, CD4+/CD8+) was determined using monoclonal antibodies (IMK Plus, Becton Dickinson, USA) by means of flow cytometry (FASCalibur E2085), IgA, IgM and IgG, serum immunoglobulin level – by means of simple radial immunodiffusion in gel (Mancini method). The functional activity of neutrophils was estimated by the phagocytosis test according to phagocytic activity and phagocytic number, as well as by nitro blue tetrazolium reduction test. Ten patients with stable compression of the roots of lumbar spine were considered as the control group. Results. AMS occurred for 8 (14.81 %) patients. The clinical picture of AMS developed quickly on the 3rd-7th day after the operation. In the clinical blood count, leukocytosis was noted without significant fluctuations, high ESR. The analysis of the peripheral blood immunity parameters of patients with AMS showed no signs of infectious or autoimmune inflammation. The changes were indolent, atypical and short-term. The rates returned to normal ones within 3 weeks. In our opinion, the following laboratory indicators can show the risk of AMS developing in the preoperative period: a decrease in the number of lymphocytes and eosinophils, an increase in the number of monocytes of the peripheral blood. It is possible to assume, that a greater risk of AMS developing arises in special areas of localization (convextic-associated with the liquoronal pathways, the ventricles of the cerebrum and the posterior cranial fossa) and tumors of individual histological variants (anaplastic cystic meningiomas and glial tumors with cystic component, with necrosis and sarcolysis of the tumor itself). Conclusions. Eradication of cystic meningioma of the brain, the prevention of cystic fluid entering the cerebrospinal fluid, the rational use of glucocorticoids within 5-10 days after the operation can significantly reduce the frequency of ASM occurrence. When evidence of meningitis appear, it is mandatory to differentiate between it and bacterial meningitis and to extract cystic components from the cerebrospinal fluid and reduce the inflammatory response of the cerebral meninges by means of glucocorticoids.