内镜经鼻入路颅底软骨肉瘤切除术后铅黄肠球菌脑膜炎合并顽固性脑脊液漏一例

铅黄肠球菌脑膜炎十分罕见，它属于具有高致死率的肠球菌脑膜炎，但目前对其临床特点和预后了解很少，对其诊断和治疗也缺乏经验。我们在此报道一例特殊的术后铅黄肠球菌脑膜炎病例。这是一位50岁男性患者，罹患广泛累及中颅底的巨大软骨肉瘤，在内镜经鼻入路全切肿瘤的过程中，鞍结节区发生硬脑膜缺损，术中予人工硬脑膜修补，但患者术后发生反复发作的脑膜炎、难治性脑脊液漏和间断性颅高压，脑膜炎和颅高压导致两次经鼻内镜脑脊液漏修补术失败。在第二次脑膜炎发作时，多次脑脊液培养证实脑膜炎致病菌为万古霉素耐药性铅黄肠球菌。铅黄肠球菌脑膜炎最终通过敏感抗生素利奈唑胺治疗和反复腰穿引流治愈，随后，通过第三次内镜经鼻入路多层修补术和同时进行的腰大池腹腔分流术成功治愈脑脊液漏。在至今两年的随访过程中未见脑膜炎、脑脊液漏和颅高压复发。

Enterococcus casseliflavus meningitis with refractory cerebrospinal fluid leakage following endoscopic endonasal removal of skull base chondrosarcoma

Meningitis caused by enterococcus casseliflavus is extremely rare and among the enterococcal meningitis which is associated with high mortality. We report an unusual case of enterococcus casseliflavus meningitis in a 50-year-old man after total removal of a giant chondrosarcoma extensively involving middle skull base via endoscopic endonasal approach. Postoperatively, the patient experienced repeated meningitis, refractory cerebrospinal fluid leakage and intracranial hypertension. Two leakage repairs failed because of meningitis and intracranial hypertension. In the second episode of meningitis, multiple cerebrospinal fluid cultures yielded vancomycin-resistant enterococcus casseliflavus. The meningitis was successfully treated with linezolid and lumbar drainage, the cerebrospinal fluid leakage was subsequently managed by the third endoscopic multilayer repair and simultaneous lumboperitoneal shunt. In two-year follow-up, there were no signs of meningitis, cerebrospinal fluid leakage or intracranial hypertension recurrences.