Laura Milanese1, Matteo Zoli2, Giacomo Sollini3, Chiara Martone4, Corrado Zenesini5, Carmelo Sturiale2, Paolo Farneti6, Giorgio Frank2, Ernesto Pasquini4, Diego Mazzatenta7. 1. Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto delle Scienze Neurologiche, Bologna, Italy. Electronic address: laura_ny10@yahoo.com. 2. Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto delle Scienze Neurologiche, Bologna, Italy. 3. ENT Department, Ospedale Bellaria, Bologna, Italy; Department of Otorhinolaryngology - Head and Neck Surgery, University of Genova, Genova, Italy. 4. ENT Department, Ospedale Bellaria, Bologna, Italy. 5. Epidemiology and Biostatistics Service, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto delle Scienze Neurologiche, Bologna, Italy. 6. Department of Experimental, Diagnostic and Specialty Medicine, Bologna University of Bologna, Bologna, Italy. 7. Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto delle Scienze Neurologiche, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
Abstract
OBJECTIVE: Postoperative infection is a potentially dramatic consequence in endoscopic endonasal surgery. The aim of this study was to assess the efficacy of our intraoperative antibiotic prophylaxis by analyzing the risk factors of postoperative meningitis in our series. METHODS: Each endoscopic endonasal procedure performed since 1998 in patients with no preoperative infections and a follow-up longer than 30 days were included and retrospectively reviewed. Antibiotic protocol consisted in single antibiotic administration of ampicillin/sulbactam 3 g or cefazolin 2 g on induction; no postoperative administrations were performed after 2005. All cases of cerebrospinal fluid (CSF) leak, meningitis, and systemic infection were recorded. RESULTS: Two thousand thirty-two procedures matched the inclusion criteria (median age 50 years; range: 1-89 years, male/female ratio: 1:1.12). Intraoperative CSF leak occurred in 32.8% of the cases and postoperative CSF leak in 3.4%. The rate of meningitis was 0.69%; other systemic infections were observed in 0.44% of cases. Meningitis was statistically associated with intra- and postoperative CSF leak (P < 0.001). Other risk factors were the intradural extension of the tumors and their malignant histology. Extended approaches producing wide osteodural defects were correlated with a greater risk of meningitis (P < 0.001). CONCLUSIONS: All surgical maneuvers to prevent, detect, and quickly repair intra- and postoperative CSF leak are crucial to avoid postoperative meningitis. The proposed prophylaxis protocol is comparable in safety to those recommended in literature as assessed by the low rate of meningitis.
OBJECTIVE:Postoperative infection is a potentially dramatic consequence in endoscopic endonasal surgery. The aim of this study was to assess the efficacy of our intraoperative antibiotic prophylaxis by analyzing the risk factors of postoperative meningitis in our series. METHODS: Each endoscopic endonasal procedure performed since 1998 in patients with no preoperative infections and a follow-up longer than 30 days were included and retrospectively reviewed. Antibiotic protocol consisted in single antibiotic administration of ampicillin/sulbactam 3 g or cefazolin 2 g on induction; no postoperative administrations were performed after 2005. All cases of cerebrospinal fluid (CSF) leak, meningitis, and systemic infection were recorded. RESULTS: Two thousand thirty-two procedures matched the inclusion criteria (median age 50 years; range: 1-89 years, male/female ratio: 1:1.12). Intraoperative CSF leak occurred in 32.8% of the cases and postoperative CSF leak in 3.4%. The rate of meningitis was 0.69%; other systemic infections were observed in 0.44% of cases. Meningitis was statistically associated with intra- and postoperative CSF leak (P < 0.001). Other risk factors were the intradural extension of the tumors and their malignant histology. Extended approaches producing wide osteodural defects were correlated with a greater risk of meningitis (P < 0.001). CONCLUSIONS: All surgical maneuvers to prevent, detect, and quickly repair intra- and postoperative CSF leak are crucial to avoid postoperative meningitis. The proposed prophylaxis protocol is comparable in safety to those recommended in literature as assessed by the low rate of meningitis.
Authors: Morcos N Nakhla; Tara J Wu; Emmanuel G Villalpando; Reza Kianian; Anthony P Heaney; Marvin Bergsneider; Marilene B Wang Journal: J Neurol Surg B Skull Base Date: 2021-10-11