Liu Yang, Feng Ming, Yao Yong, Deng Kan, Bao Xinjie, Liu Xiaohai, Wang Renzhi
Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Medicine (Baltimore). 2017 Jul;96(28):e7124. doi: 10.1097/MD.0000000000007124.
Microbial infection should be regarded in the differential diagnosis of neurosurgical complications after transnasal transsphenoidal pituitary microsurgery, albeit cryptococcal meningitis is rare. This article will discuss the risk factors of cryptococcal meningitis in patients underwent transnasal transsphenoidal pituitary microsurgery, and summary the potential origins of infection.
Here, we report a case of 37-year-old male who had cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of a relapsing ACTH-secreting pituitary adenoma.
Standard therapy for Cryptococcus neoformans (fluconazole [400 mg per day] and flucytosine) was administered and followed by maintenance dose.
The patient had been on treatment for one and a half years during follow-up and reported neurologically well with repeated negative cerebrospinal fluid (CSF) culture until sudden death of heart arrest.
C neoformans can be a possible cause of meningitis in immunocompetent patients after transnasal transsphenoidal pituitary microsurgery. Risk factors, such as pre-existed pulmonary infection and Cushing-associated hypercortisolemia, should be stressed. Promising preventive measures may include preoperative routine sputum smear and India-ink stain for screening, preoperative treatment of cryptococcal pneumonia, postoperative antibiotic management, and a more secure skull base reconstruction. Radiation and pharmaceutical treatment may be alternative for recurrent Cushing disease.
微生物感染应纳入经鼻蝶窦垂体显微手术后神经外科并发症的鉴别诊断中，尽管隐球菌性脑膜炎较为罕见。本文将探讨经鼻蝶窦垂体显微手术患者发生隐球菌性脑膜炎的危险因素，并总结潜在的感染源。
在此，我们报告一例37岁男性患者，该患者在复发性促肾上腺皮质激素分泌型垂体腺瘤经鼻蝶窦垂体显微手术后发生了隐球菌性脑膜炎。
给予新型隐球菌的标准治疗（氟康唑[每日400毫克]和氟胞嘧啶），随后给予维持剂量。
在随访期间，该患者接受了一年半的治疗，报告称神经系统状况良好，脑脊液培养反复呈阴性，直至因心脏骤停突然死亡。
新型隐球菌可能是经鼻蝶窦垂体显微手术后免疫功能正常患者发生脑膜炎的一个原因。应强调诸如既往肺部感染和库欣综合征相关的高皮质醇血症等危险因素。有前景的预防措施可能包括术前常规痰涂片和墨汁染色筛查、术前治疗隐球菌性肺炎、术后抗生素管理以及更可靠的颅底重建。对于复发性库欣病，放疗和药物治疗可能是替代方案。
