The symposium is co-organised by The Ann Conroy Trust, in association with Aesculap Academia.
The Ann Conroy Trust is Registered Charity No: 1165808.
We provide Support, Education and Research for patients living with Chiari Malformation, Syringomyelia and associated conditions.
F26 Is cerebrospinal fluid pleocytosis a good indicator of post-operative aseptic meningitis following craniovertebral decompression?
Asha MJ, Flint G.
Differentiation between chemical and bacterial meningitis, following intracranial surgery, can be challenging. Current recommendations advocate use of broad-spectrum antibiotics in the presence of CSF pleocytosis, pending final cultures. We examined the implications of this recommendation in the context of craniovertebral decompression for Chiari 1 malformation.
Records of 225 patients with symptomatic Chiari 1 malformation, with or without syringomyelia, who underwent craniovertebral decompression between 1995 and 2016, were reviewed retrospectively. Patients with clinically suspected meningitis were studied in detail. Initial CSF analysis was examined and results correlated with final microbial cultures. Other variables studied were patient demographics, presence of hydrocephalus, occurrence of postoperative CSF leak, use of prophylactic antimicrobials, length of hospital stay and clinical outcome.
34 of the 225 patients (15%) were suspected of having meningitis. CSF analysis showed pleocytosis in all these cases. The total white cell count was, however, widely variable and polymorphonuclear predominance was detected in 65% of cases. Final cultures confirmed that 3 of these 34 cases (less than 1 in 10) had bacterial meningitis. There was no significant difference in total white cell count, polymorphonuclear predominance, or CSF lactate between cases of aseptic and bacterial meningitis. CSF leak was documented in all 3 cases with bacterial meningitis but only two of the 31patients with chemical meningitis. No difference in the incidence of hydrocephalus was detected between the two groups. Despite negative cultures, antibiotics were continued in half of all suspected cases where treatment had been commenced.
In the context of clinically suspected meningitis in the postoperative period, CSF pleocytosis is not a strong indicator for starting antibiotic therapy. Patients who appear clinically septic and/or have developed CSF leakage appear