A Case of Recurrent Postoperative Aseptic Meningitis after Craniopharyngioma Resection

Abstract

Objectives:

1) Describe a case of aseptic meningitis following craniopharyngioma resection. 2) Review of literature and pathophysiology surrounding aseptic meningitis secondary to cranipharyngioma resection. 3) Recognize diagnostic and management difficulties regarding this phenomenon.

Methods:

This is a case report of a 65-year-old female with a compressive craniopharyngioma who underwent endoscopic trans-sphenoidale resection followed by aseptic meningitis, regrowth, open re-resection, and recurrence of meningitis.

Results:

The patient was found to have a cranoiopharyngioma on magnetic resonance imaging after presentation with 2-months of diplopia. She underwent trans-sphenoidale resection with improved vision post-operatively. However, she presented to the emergency department (ED) with fatigue and fever concerning for meningitis. Cerebrospinal fluid (CSF) analysis demonstrated elevated leukocytes and total protein, and normal glucose levels consistent with meningitis. Cultures returned sterile. She was discharged on long-term antibiotics. Unfortunately, her craniopharyngioma regrew requiring open craniotomy re-resection. She did well post-operatively but presented to the ED with altered mental status, emesis, and fever. Again, CSF analysis was sterile with elevated leukocytes and total protein. She was treated with another course of long-term antibiotics. After radiation therapy, repeat MRIs found no regrowth of her craniopharyngioma.

Conclusions:

Aseptic meningitis after craniopharyngioma resection is a rare phenomenon but can introduce a diagnostic and management conundrum. This case highlights the importance of awareness for chemical-induced meningitis following craniopharyngioma resection. While symptomatic relief is important, the course of antibiotic coverage is controversial. Coordinated multi-team efforts are necessary to provide optimal care for these patients.