Surgical intervention and heparin-anticoagulation improve prognosis of rhinogenic/otogenic and posttraumatic meningitis.
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, independent 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 dependent 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.(ABSTRACT TRUNCATED AT 250 WORDS)
Winkler
J
J
Department of Neurology, University of Würzburg, Germany.
Bogdahn
U
U
Becker
G
G
Durant
W
W
Brunner
F X
FX
Eckstein
M
M
Brawanski
A
A
Warmuth
M
M
Mertens
H G
HG
D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents; D001930:Brain Injuries / Q000401:mortality / Q000601:surgery*; D002558:Cerebrospinal Fluid Otorrhea / Q000401:mortality / Q000601:surgery*; D002559:Cerebrospinal Fluid Rhinorrhea / Q000401:mortality / Q000601:surgery*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009460:Neurologic Examination; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D006493:Heparin