Delayed Meningitis Complicated by the Frontal Sinus Opening to the Dura Mater in a Patient with Intracranial Injury Fifteen Years Ago

Jaesik Shin; Sunghan Oh; Bongsub Chung; Jongkook Rhim; Chungjae Lee; Jongwon Choi

doi:10.13004/kjnt.2013.9.2.142

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Shin, Oh, Chung, Rhim, Lee, and Choi: Delayed Meningitis Complicated by the Frontal Sinus Opening to the Dura Mater in a Patient with Intracranial Injury Fifteen Years Ago

Case Report

Korean J Nutr 2013;9(2):142-145.

Published online: 20 October 2013

DOI: https://doi.org/10.13004/kjnt.2013.9.2.142

Delayed Meningitis Complicated by the Frontal Sinus Opening to the Dura Mater in a Patient with Intracranial Injury Fifteen Years Ago

Jaesik Shin, MD, Sunghan Oh, MD, Bongsub Chung, MD, Jongkook Rhim, MD, Chungjae Lee, MD, Jongwon Choi, MD

Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea

Address for correspondence: Sunghan Oh, MD Department of Neurosurgery, Bundang Jesaeng General Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 463-774, Korea Tel: +82-31-779-0285, Fax: +82-31-779-0895 E-mail: swalme@hanmail.net

Received 15 September 2013 Revised 7 October 2013 Accepted 7 October 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Meningitis is the inflammation of the membranes of the brain and spinal cord. This disease is considered life threatening and classified as a medical and emergency. Here we report a case of delayed meningitis occurred in a patient with craniotomy for traumatic brain injury fifteen years ago. Meanwhile, he had been well, however he complained of headache for five days. A brain computed tomographic scan showed air density on the frontal lobe with frontal sinus defect and pansinusitis. His mental state was suddenly changed to stuporous, despite a day of empirical antibiotics. Therefore, a successful cranial-ization was performed and he was gradually improved. This is a rare case report. Our case shows that surgical intervention is to be considered in some cases of posttraumatic meningitis for effective and rapid control of infection.

Keywords: Basal skull fracture, Cranialization, Meningitis

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FIGURE 1.

Axial and coronal brain CT scan showing pneumocephalus with frontal sinus opening to the left frontal lobe.

FIGURE 2.

Operative photographs demonstrating the cranialization procedure. A: Removal anterior wall of the frontal sinus. B: Removal of the granulated and inflamed wall of the frontal sinus. C: Meticulous extirpation of the frontal sinus mucosa. D: Flapping with the pericranial fascia to close the sinonasal tract. E: Packing the empty cavity with free fat tissue. F: Reconstruction of the anterior wall of the frontal sinus with a Mesh sheet.

FIGURE 3.

The high power microscopic finding demonstrating abscess formation, predominantly neutrophils (H&E, ×200).

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