Assessment and management of meningitis following cerebellopontine angle surgery

Abstract

The development of postoperative meningitis is a known complication of surgery in the cerebellopontine angle. The management of meningitis and suspected meningitis following surgery in the cerebellopontine angle is of particular interest to neurotologists and others operating in this region. Both bacterial and aseptic meningitis are known to occur in the postoperative period. Substantial differences exist between community-acquired meningitis and postoperative meningitis. Mortality from postoperative bacterial meningitis is rare in patients undergoing resection of an acoustic neuroma. In most instances, reliable early differentiation of bacterial versus aseptic meningitis is not currently possible. Guidance in the management of postoperative patients suspected of having meningitis is available in the literature. The evaluation and management of postoperative meningitis following cerebellopontine angle surgery can be complex. The majority of patients suspected of having postoperative meningitis should be treated with intravenous steroids and antibiotics at least until culture results are finalized, though alternative treatment pathways may be suitable for carefully selected patients. The prompt treatment of bacterial meningitis with steroids and antibiotics is imperative. For patients with postoperative aseptic meningitis, we advocate that the clinician give consideration to steroid treatment.