Chemical meningitis after cerebral aneurysm treatment using two second-generation aneurysm coils: Report of two cases
Chemical meningitis after cerebral aneurysm treatment using two second-generation aneurysm coils: Report of two cases
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DOI：
10.1227/01.neu.0000140987.71791.df
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发表时间：
2004-11-01
期刊：
影响因子：
4.8
通讯作者：
Connolly, ES
中科院分区：
文献类型：
--
作者：
Meyers, PM;Lavine, SD;Connolly, ES
目标和重要性：在寻求有效和持久的血管内动脉瘤治疗过程中，第二代动脉瘤弹簧圈奋进于增加对植入材料的生物愈合反应。我们报告了两例大的脑动脉瘤同时治疗两个可用的第二代动脉瘤弹簧圈和随后的发展症状性nonbacterial meningitis.CLINICAL PRESENTATION：两个以前健康的患者进行血管内治疗大（大于或等于2厘米）脑动脉瘤。使用多个水凝胶弹簧圈（MicroVention，Inc.，阿利索·维耶霍，CA）和Matrix线圈（Boston Scientific/Target，Fremont，CA）。在整个手术过程中观察到仔细的无菌技术，并在围手术期对两名患者进行预防性静脉注射抗生素。治疗进展顺利，在这两种情况下，优秀的动脉瘤闭塞，没有立即术后神经defictions.INTERVENTION：在这两种情况下，患者出院，但很快再入院的脑膜炎的柱头。影像学显示两例患者的动脉瘤均持久闭塞，并且异常提示动脉瘤周围和弥漫性颅内炎症反应。完整的脓毒性检查未能在两名患者中识别出微生物。两名患者都对用于调节弹簧圈植入物引起的炎症反应的皮质类固醇药物治疗有反应。结论：开发第二代动脉瘤弹簧圈是为了通过促进更完全的动脉瘤容积闭塞或引发更多的炎症反应来促进更持久的脑动脉瘤闭塞。在大型动脉瘤中同时使用水凝胶和Matrix弹簧圈系统可能会引起局部和全身表现的强烈炎症反应。尽管在所有此类病例中需要对假定的细菌性脑膜炎进行警惕的评估和治疗，但患者对皮质类固醇免疫调节治疗有反应。需要更多信息来更好地了解水凝胶和Matrix弹簧圈的相互作用。
OBJECTIVE AND IMPORTANCE: In the quest for effective and durable endovascular aneurysm treatment, second-generation aneurysm coils endeavor to increase the biological healing response to the implanted material. We report two cases of large cerebral aneurysms treated concurrently with both available second-generation aneurysm coils and the subsequent development of symptomatic nonbacterial meningitis.CLINICAL PRESENTATION: Two previously healthy patients underwent endovascular treatment for large (greater than or equal to2 cm) cerebral aneurysms. Both aneurysms were treated using multiple Hydrogel coils (MicroVention, Inc., Aliso Viejo, CA) and Matrix coils (Boston Scientific/Target, Fremont, CA). Careful aseptic technique was observed throughout each procedure, and prophylactic intravenous antibiotics were administered during the perioperative period to both patients. Treatment proceeded uneventfully in both cases with excellent aneurysm occlusion and no immediate postoperative neurological deficits.INTERVENTION: In both cases, the patients were discharged from hospital but quickly were readmitted with stigmata of meningitis. Imaging demonstrated durable occlusion of the aneurysms in both patients and also abnormalities indicative of perianeurysmal and diffuse intracranial inflammatory response. Complete septic workup failed to identify an organism in either patient. Both patients responded to treatment with corticosteroid medication used to modulate the inflammatory response induced by the coil implants.CONCLUSION: Second-generation aneurysm coils were developed to promote more durable occlusion of cerebral aneurysms by promoting more complete volumetric aneurysm occlusion or by eliciting a more prolific inflammatory response. The concurrent use of Hydrogel and Matrix coil systems in large aneurysms may cause an exuberant inflammatory response with both local and systemic manifestations. Although vigilant evaluation and treatment for presumptive bacterial meningitis is required in all such cases, patients respond to immunomodulatory therapy with corticosteroids. More information to understand better the interaction of Hydrogel and Matrix coils is needed.