Eosinophilic meningitis from bovine graft duraplasty treated without explantation

Abstract

Aseptic cerebrospinal fluid eosinophilia is a rare complication associated with the use of bovine dural graft. It is thought to represent an inflammatory response to the foreign body. In previous case reports of children and adults, treatment has involved graft explantation, antibiotics or systemic corticosteroids. We describe the case of a 36 year old female who underwent posterior fossa craniotomy for tumour and repair with Durepair (Medtronic), a bovine collagen graft. One month later, she presented with aseptic eosinophilic meningitis. This was successfully treated with an extended course of oral dexamethasone, and no further surgery was required. She remained asymptomatic at 1 year follow up. A review of the literature on allergic eosinophilic meningitis as response to dural substitutes was conducted, with a focus on dural graft types and management.We conclude that aseptic eosinophilic meningitis is a rare complication after duraplasty, particularly in adults. CSF eosinophilia confirms that the pathology is not bacterial postoperative infection. Management with corticosteroids can be successful in treating this inflammatory reaction and does not require antibiotics or explantation of the allergenic material.

Keywords

• Aseptic meningitis
• Cerebrospinal fluid eosinophilia
• Bovine collagen dural graft