Prolonged postoperative
pyrexia (PPP) due to Mollaret's
meningitis following endoscopic transsphenoidal surgery (eTSS) for an intracranial
epidermoid cyst can be confused with postoperative meningeal
infection after transsphenoidal resection, especially in the middle of the
COVID-19 pandemic.
Anosmia, as well as
dysgeusia, cannot be evaluated in patients of eTSS for a while after surgery. We report a case of an infundibular
epidermoid cyst with post-eTSS Mollaret's
meningitis (MM). The post-eTSS MM caused
vasopressin-analogue-resistant
polyuria (VARP) in synchronization with PPP. A 59-year-old man experiencing recurrent
headaches and irregular
bitemporal hemianopsia over three months was diagnosed with a suprasellar
tumor. The suprasellar
tumor was an infundibular
cyst from the infundibular recess to the posterior lobe of the pituitary, which was gross-totally resected including the neurohypophysis via an extended eTSS. Since awakening from
general anesthesia after the gross total resection (GTR) of the
tumor, the patient continuously had suffered from
headache until the 13th postoperative day (POD13). The patient took
analgesics once a day before the surgery and three times a day after the surgery until POD11.
Pyrexia (37.5-39.5 degree Celsius) in synchronization with nonnephrogenic VARP remitted on POD18. Intravenous
antibiotics had little effect on changes of
pyrexia. Serum
procalcitonin values (reference range <0.5 ng/mL) are 0.07 ng/mL on POD12 and 0.06 ng/mL on POD18. His
polyuria came to react with sublingual
desmopressin after alleviation of
pyrexia. He left the hospital under
hormone replacement therapy without newly added neurological sequelae other than
hypopituitarism. After GTR of an infundibular
epidermoid cyst, based on values of serum
procalcitonin, post-eTSS MM can be distinguished from
infection and can be treated with symptomatic treatments. The postoperative transient nonnephrogenic VARP that differs from usual
central diabetes insipidus can react with sublingual
desmopressin after alleviation of PPP in the
clinical course of post-eTSS MM. An infundibular
epidermoid cyst should be sufficiently resected in one sitting to minimize comorbidities, its recurrence, or postoperative MM to the utmost.