Role of perioperative antibiotics in endoscopic skull base surgery. Academic Article uri icon

Overview

abstract

  • OBJECTIVES/HYPOTHESIS: Direct connection between the sinonasal and intracranial cavities and passage of multiple instruments and graft materials through a contaminated field occur routinely during endoscopic pituitary and skull base surgery. Despite the theoretical risk of intracranial contamination with sinonasal flora, the incidence of central nervous system (CNS) infection following such procedures is not well documented, and the ideal antibiotic regimen has yet to be determined. STUDY DESIGN: Prospective case series of 24 to 48 hours of single-agent perioperative antibiotics in patients undergoing endoscopic skull base surgery. METHODS: Prospective database of procedures performed between January 2004 and May 2006 was reviewed for antibiotic use and infectious complications. RESULTS: The diagnoses of the 90 patients in this series included pituitary tumor (62%), craniopharyngioma (9%), encephalocele (9%), and meningioma (8%). Fifty-eight (64%) patients experienced intraoperative cerebrospinal fluid (CSF) leak. A variety of autologous, synthetic grafts, hemostatic agents, and tissue sealants were placed through the sinonasal cavity for reconstruction. All patients received 24 to 48 hours of a single antibiotic based on patient sensitivity: cefazolin (87%), vancomycin (10%), or clindamycin (3%). Additional antibiotics were subsequently required during the hospital stay in eight (9%) patients for a variety of indications. There were no cases of intracranial infections or meningitis in patients with or without intraoperative CSF leak. CONCLUSIONS: Despite direct contamination of the intracranial cavity during endoscopic, endonasal skull base surgery, the risk of CNS infections is low. Limited use of a single perioperative antibiotic may be sufficient prophylaxis.

publication date

  • September 1, 2007

Research

keywords

  • Antibiotic Prophylaxis
  • Craniotomy
  • Endoscopy
  • Skull Base

Identity

Scopus Document Identifier

  • 34548414104

Digital Object Identifier (DOI)

  • 10.1097/MLG.0b013e3180caa177

PubMed ID

  • 17667141

Additional Document Info

volume

  • 117

issue

  • 9