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One Thousand Endoscopic Skull Base Surgical Procedures Demystifying the Infection Potential: Incidence and Description of Postoperative Meningitis and Brain Abscesses

Published online by Cambridge University Press:  02 January 2015

Yuriko Kono ,
Daniel M. Prevedello ,
Carl H. Snyderman ,
Paul A. Gardner ,
Amin B. Kassam ,
Ricardo L. Carrau  and
Karin E. Byers
Yuriko Kono*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Daniel M. Prevedello
Affiliation:
Department of Neurological Surgery, Ohio State University, Columbus, Ohio
Carl H. Snyderman
Affiliation:
Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
Paul A. Gardner
Affiliation:
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania
Amin B. Kassam
Affiliation:
Neuroscience Institute, Saint lohn's Health Center, Santa Monica, California
Ricardo L. Carrau
Affiliation:
Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania
Karin E. Byers*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
*
3601 Fifth Avenue, Suite 3A, Pittsburgh, PA 15213 (konoy2@upmc.edu)
3601 Fifth Avenue, Suite 3A, Pittsburgh, PA 15213 (keb62@pitt.edu)
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Abstract

Background.

Endonasal endoscopic skull base surgery (ESBS) is perceived as having a high risk of infection because it is performed through the sinuses, which are not sterile.

Objective.

To identify the bacteriological characteristics, incidence, mortality, and risk factors for intracranial infection after ESBS.

Methods.

A retrospective analysis of the first 1,000 ESBS procedures performed at the University of Pittsburgh Medical Center from 1998 to 2008.

Results.

In 18 cases (1.8%), the patient developed meningitis. In 2 cases, the patient died within 2 months after surgery, of noninfectious causes. In 11 cases, cerebrospinal fluid (CSF) cultures had positive results. There were no predominant pathogens. Male sex (odds ratio [OR], 3.97 [95% confidence interval {CI}, 1.21-13.03]; P = .02), history of a craniotomy or endonasal surgery (OR, 4.77 [95% CI, 1.68-13.56];P = .003), surgerywith higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70];P = .005), the presence of an external ventricular drain or ventriculoperitoneal shunt at the time of surgery (OR, 6.38 [95% CI, 1.07-38.09]; P = .04), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P<.001) were risk factors for infection.

Conclusion.

The incidence of infection of 1.8% in ESBS is comparable to that in open craniotomy. The most important risk factor was a postoperative CSF leak. All patients recovered from their infection.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 1 , January 2011 , pp. 77 - 83
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Fatemi, N, Dusick, JR, de Paiva Neto, MA, Kelly, DF. The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10-year experience. Neurosurgery 2008;63(4 suppl 2):244–256.Google Scholar
2.Snyderman, C, Kassam, A, Carrau, R, Mintz, A, Gardner, P, Prevedello, DM. Acquisition of surgical skills for endonasal skull base surgery: a training program. Laryngoscope 2007;117:699–705.Google Scholar
3.van Aken, MO, Feelders, RA, de Marie, S, et al. Cerebrospinal fluid leakage during transsphenoidal surgery: postoperative external lumbar drainage reduces the risk for meningitis. Pituitary 2004;7:89–93.Google Scholar
4.van Aken, MO, de Marie, S, van der Lely, AJ, et al. Risk factors for meningitis after transsphenoidal surgery. Clin Infect Dis 1997;25:852–856.Google Scholar
5.Dumont, AS, Nemergut, EC II, Jane, JA Jr, Laws, ER Jr. Postoperative care following pituitary surgery. J Intensive Care Med 2005;20:127–140.Google Scholar
6.Korinek, AM, Baugnon, T, Golmard, JL, van Effenterre, R, Coriat, P, Puy-basset, L. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 2006;59:126–133.CrossRefGoogle ScholarPubMed
7.Korinek, AM, Golmard, JL, Elcheick, A, et al. Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4578 patients. Br J Neurosurg 2005;19:155–162.Google Scholar
8.Korinek, A-M; French Study Group of Neurosurgical Infections, the SEHP, and C-CLIN Paris-Nord. Risk factors for neurosurgical site in-fections after craniotomy: a prospective multicenter study of 2944 patients. Neurosurgery 1997;41:1073–1079.Google Scholar
9.National Nosocomial Infections Surveillance system. National Nosocomial Infections Surveillance system repost, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
10.Reichert, MC, Medeiros, EA, Ferraz, FA. Hospital-acquired meningitis in patients undergoing craniotomy: incidence, evolution, and risk factors. Am J Infect Control 2002;30:158–164.Google Scholar
11.Snyderman, CH, Carrau, RL, Kassam, AB, et al. Endoscopic skull base surgery: principles of endonasal oncological surgery. J Surg Oncol 2008; 97:658–664.CrossRefGoogle ScholarPubMed
12.Gardner, PA, Kassam, AB, Thomas, A, et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008;63:36–54.Google Scholar
13.Dellinger, EP, Gross, PA, Barrett, TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin Infect Dis 1994;18:422–427.CrossRefGoogle ScholarPubMed
14.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice. 1st ed. St.Louis: Mosby, 1996:A1–A20.Google Scholar
15.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250–278.Google Scholar
16.Donald, PJ. Complications in skull base surgery for malignancy. Laryngoscope 1999;109:1959–1966.Google Scholar
17.Kryzanski, JT, Annino, DJ, Gopal, H, Heilman, CB. Low complication rates of cranial and craniofacial approaches to midline anterior skull base lesions. Skull Base 2008;18:229–241.Google Scholar
18.Hull, MW, Chow, AW. Indigenous microflora and innate immunity of the head and neck. Infect Dis Clin North Am 2007;21:265–282.Google Scholar
19.Friedman, JA, Ebersold, MJ, Quast, LM. Persistent posttraumatic cerebrospinal fluid leakage. Neurosurg Focus 2000;9(1):e1.Google ScholarPubMed
20.Sudhakar, N, Ray, A, Vafidis, JA. Complications after trans-sphenoidal surgery: our experience and a review of the literature. Br J Neurosurg 2004;18:507–512.Google Scholar
21.Deschler, DG, Gutin, PH, Mamelak, AN, McDermott, MW, Kaplan, MJ. Complications of anterior skull base surgery. Skull Base Surg 1996;6:113–118.Google Scholar
22.Feiz-Erfan, I, Han, PP, Spetzler, RF, et al. The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg 2005;103:485–490.Google Scholar
23.de Divitiis, E, Cappabianca, P, Cavallo, LM, Esposito, F, de Divitiis, O, Messina, A. Extended endoscopic transsphenoidal approach for extrasellar craniopharyngiomas. Neurosurgery 2007;61:219–227.Google Scholar
24.de Divitiis, E, Cavallo, LM, Esposito, F, Stella, L, Messina, A. Extended endoscopic transsphenoidal approach for tuberculum sellae meningiomas. Neurosurgery 2008;62:1192–1201.Google Scholar
25.Frank, G, Pasquini, E, Doglietto, F, et al. The endoscopic extended transsphenoidal approach for craniopharyngiomas. Neurosurgery 2006;59:ONS75–ONS83.Google Scholar
26.Kassam, AB, Thomas, A, Carrau, RL, et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008;63:ONS44–ONS52.Google Scholar
27.Cavallo, LM, Prevedello, DM, Solari, D, et al. Extended endoscopic endonasal transsphenoidal approach for residual or recurrent craniopharyngiomas. J Neurosurg 2009;111:578–589.Google Scholar
28.Hadad, G, Bassagasteguy, L, Carrau, RL, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006;116:1882–1886.Google Scholar