Risk factors for meningitis after trans-sphenoidal surgery for pituitary adenomas

Abstract

Objective. Determinations of possible risk factors for postoperative meningitis in patients with pituitary tumours undergoing trans-sphenoidal surgery. Methods. Retrospective analysis of pre- and postoperative data on 228 patients having trans-septal transphenoidal pituitary gland surgery. Conventional radiographs of the paranasal sinuses were taken preoperatively. Bacterial survey of nasal swabs was undertaken. All patients received Amoxycillin for 6 days. Results. The incidence of meningitis was 3.1% (7/228). The average onset of first symptoms was 12 days (range 4–20 days) postoperatively. Meningitis was seen more in patients having Cushing’s disease (4/7). Preoperative nasal swabs had no predictive value for meningitis. Preoperative radiographs showed abnormalities in 28 patients of whom three patients suffered from sinusitis. Meningitis occurred in two of these threepatients. Intraoperative CSF-leakage was treated immediately with lumbar drainage. In none of these patients was meningitis seen. Postoperative CSF-leakage resulted ultimately in meningitis in six patients, despite adequate lumbar drainage. Conclusion. Postoperative CSF-leakage was the major risk factor for meningitis after transsphenoidal pituitary gland surgery, especially in patients with Cushing’s disease.