title: Delayed intracranial abscess after acoustic neuroma surgery: a report of two cases.
abstract: OBJECTIVE
  The use of antibiotics before and after surgery has made infectious complications of neurotologic surgery rare. The neurosurgical literature cites a rate of postoperative meningitis between 1% and 2% for "clean" cases and 1.5% to 2.5% for "clean contaminated" cases, such as cerebrospinal fluid contact with the middle ear or mastoid. Reports of infections after neurotologic procedures are rare in the otologic literature. In this report, two patients with brain abscess occurring in a delayed fashion after surgery are described.
  
  
  METHODS
  The study design was a retrospective chart review and case report.
  
  
  METHODS
  The study was conducted at a tertiary referral center.
  
  
  RESULTS
  Patient 1 underwent a suboccipital craniotomy for removal of an acoustic neuroma and had an uneventful postoperative recovery. Three months after surgery, he reported mild unsteadiness. Examination revealed mild ataxia, which led to repeat magnetic resonance imaging (MRI) and a diagnosis of cerebellar abscess. Patient 2 underwent translabyrinthine removal of an acoustic neuroma complicated by postoperative Pseudomonas aeruginosa meningitis, which responded promptly to intravenous antibiotics. Fifteen months after surgery, he visited a neurologist after having a seizure and was treated with anticonvulsants. After a second episode of seizure, imaging studies showed a temporal lobe abscess.
  
  
  CONCLUSIONS
  The signs of intracranial abscess may be subtle and can occur weeks or months after surgery, requiring vigilance and a high index of suspicion for diagnosis. A change in postoperative symptoms after acoustic neuroma surgery should signal further investigation using MRI with gadolinium.
authors.affiliation: Department of Otology and Neurotology, Harvard Medical School and Massachusetts Eye and Ear Infirmary, Boston 02114, USA.
authors.forename: H
authors.initials: H
authors.lastname: Staecker
authors.forename: J B
authors.initials: JB
authors.lastname: Nadol
authors.forename: R
authors.initials: R
authors.lastname: Ojeman
authors.forename: M J
authors.initials: MJ
authors.lastname: McKenna
mesh_terms: D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000382:microbiology* / Q000473:pathology*; D003390:Cranial Nerve Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008587:Meningitis, Viral / Q000382:microbiology*; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000382:microbiology* / Q000473:pathology*; D011552:Pseudomonas Infections / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors