One thousand endoscopic skull base surgical procedures demystifying the infection potential: incidence and description of postoperative meningitis and brain abscesses.
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 = .02), surgery with higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70]; P = .003), 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 = .005), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P < .001) were risk factors for infection.


CONCLUSIONS
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.
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. konoy2@upmc.edu
Yuriko
Y
Kono
Daniel M
DM
Prevedello
Carl H
CH
Snyderman
Paul A
PA
Gardner
Amin B
AB
Kassam
Ricardo L
RL
Carrau
Karin E
KE
Byers
D000293:Adolescent; D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000453:epidemiology* / Q000401:mortality; D016001:Confidence Intervals; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D004724:Endoscopy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008581:Meningitis / Q000453:epidemiology* / Q000401:mortality; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D010414:Pennsylvania / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D019291:Skull Base / Q000601:surgery*