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Surgical intervention and heparin‐anticoagulation improve prognosis of rhinogenic/otogenic and posttraumatic meningitis
Author(s) -
Winkler J.,
Bogdahn U,
Becker G.,
Durant W.,
Brunner FX,
Eckstein M,
Brawanski A,
Warmuth M,
Mertens HG
Publication year - 1994
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/j.1600-0404.1994.tb01683.x
Subject(s) - medicine , surgery , heparin , meningitis , glasgow outcome scale , antibiotics , anesthesia , glasgow coma scale , microbiology and biotechnology , biology
It is still controversial, whether early surgical removal of infectious material and heparin‐anticoagulation to reduce vascular complications will improve outcome in acute meningitis. In the present pilot‐study 40 patients with acute or delayed post‐traumatic or oto‐/rhinogenic purulent bacterial meningitis were analysed for neurological outcome by using the Glasgow outcome score (GOS)and the Tuthill functional score; patients were treated either by early surgical revision of the septic focus (Group 1, within 6 days, n = 15), late surgery (Group 2, later than 6 days, n = 19), or no surgery at all (Group 3, n = 6). All patients, independant of surgical approach, received therapeutic heparin‐anticoagulation. Patient groups were otherwise comparable for antibiotic treatment, osmotherapy, microbiology, CSF‐findings, CT‐scans and prognostic factors. Outcome according to GOS was superior in Group 1 compared with Groups 2/3 (non‐significant). Although there was no significant difference on admission in the Tuthill functional score, Group 1 achieved a superior final outcome of 96 points compared with Groups 2 and 3, who gained 72 points (p<0.01). In addition, Group 1 patients had significantly less intracranial complications (8/15 patients versus 21/25 patients in Groups 2/3, p<0.01) and were dependant upon respirator treatment for fewer days (10.2 days) than Groups 2/3 (12.5 days, non‐significant). In 31 patients CSF‐leakage was identified: among these, 17 patients had CSF‐leakage, which had not been anticipated by clinical/neuroradiological examinations and revealed only by surgery. The overall mortality in this study population was very low (2.5%), therefore, therapeutic heparin seems to represent an additional favorable treatment measure. We conclude that early surgical exploration in posttraumatic or oto‐/rhinogenic purulent meningitis may improve clinical outcome, minimize intracranial complications, and identify latent CSF‐fistulas. A prospective, controlled study would be desirable.