Abstract
Pseudomonas aeruginosa (P. aeruginosa) frequently causes various infections, some of which are serious and require prompt medical detection and appropriate antibiotic selection. Although P. aeruginosa commonly exists within the nasal cavity, meningitis or ventriculitis following transsphenoidal surgery to relieve P. aeruginosa has been reported only occasionally. However, as the endoscopic transnasal approach is more widely utilized for the suprasellar lesions, nosocomical P. aeruginosa infection associated with cerebrospinal fluid (CSF) leakage becomes more common in patients with panhypopituitarism who undergo transsphenoidal surgery. We report a case of a 36-year-old man with an intrasellar craniopharyngioma presenting with an acute obstructive hydrocephalus caused by P. aeruginosa ventriculitis following transsphenoidal surgery. Treatment with optimal antibiotics was initiated immediately after P. aeruginosa was recognized as the pathogen, and was continued for 3 months. After removal of the infected fascia and fat graft used for the closure of CSF leakage and sellar floor reconstruction, endoscopic third ventriculostomy was successfully performed to treat the obstructive hydrocephalus induced by the occlusion of the fourth ventricle outlet, resulting in a positive outcome. Although the obstructive hydrocephalus caused by P. aeruginosa is extremely rare, prompt detection and appropriate treatment should be required once P. aeruginosa ventriculitis happens.
Highlights
Acute bacterial meningitis or ventriculitis after the transsphenoidal (TS) surgery infrequently leads to a potentially fatal situation of intraoperative cerebrospinal fluid (CSF) leakage [1] [2]
We present here a very rare case of obstructive hydrocephalus caused by P. aeruginosa infection following TS surgery
P. aeruginosa is a causative pathogen with low incidence among postoperative meningitis following TS surgeries, early detection of P. aeruginosa meningitis is mandatory for successful treatment [1] [2]
Summary
Acute bacterial meningitis or ventriculitis after the transsphenoidal (TS) surgery infrequently leads to a potentially fatal situation of intraoperative cerebrospinal fluid (CSF) leakage [1] [2]. Development of a P. aeruginosa infection in the central nervous system (CNS) can lead to serious meningitis or ventriculitis [3]. CSF leakage associated with the spread of endoscopic procedures has caused an increase in the risk of postoperative meningitis and ventriculitis, if the skull base construction could not be performed successfully. Hydrocephalus, of either the communicating or the obstructive type, is occasionally found in patients with meningitis or ventriculitis [5] [6]. We present here a very rare case of obstructive hydrocephalus caused by P. aeruginosa infection following TS surgery
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