Role of perioperative antibiotics in endoscopic skull base surgery.
OBJECTIVE
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.


METHODS
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.
Department of Otorhinolaryngology, Weill Medical College of Cornell University, New York, New York 10021, USA. sethmbrown@msn.com
Seth M
SM
Brown
Vijay K
VK
Anand
Abtin
A
Tabaee
Theodore H
TH
Schwartz
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000517:prevention & control; D002437:Cefazolin / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000601:surgery; D002981:Clindamycin / Q000627:therapeutic use; D003399:Craniotomy / Q000379:methods*; D004677:Encephalocele / Q000601:surgery; D004724:Endoscopy / Q000379:methods*; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications; D011182:Postoperative Care; D011300:Preoperative Care; D011446:Prospective Studies; D019291:Skull Base / Q000601:surgery*; D013353:Subdural Effusion; D013530:Surgical Wound Infection / Q000517:prevention & control; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002981:Clindamycin; D014640:Vancomycin; D002437:Cefazolin