Role of Perioperative Antibiotics in Endoscopic Skull Base Surgery

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...

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Veröffentlicht in:The Laryngoscope 2007-09, Vol.117 (9), p.1528-1532
Hauptverfasser: Brown, Seth M., Anand, Vijay K., Tabaee, Abtin, Schwartz, Theodore H.
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container_end_page 1532
container_issue 9
container_start_page 1528
container_title The Laryngoscope
container_volume 117
creator Brown, Seth M.
Anand, Vijay K.
Tabaee, Abtin
Schwartz, Theodore H.
description 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.
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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.</description><identifier>ISSN: 0023-852X</identifier><identifier>EISSN: 1531-4995</identifier><identifier>DOI: 10.1097/MLG.0b013e3180caa177</identifier><identifier>PMID: 17667141</identifier><identifier>CODEN: LARYA8</identifier><language>eng</language><publisher>Hoboken, NJ: John Wiley &amp; Sons, Inc</publisher><subject>Anti-Bacterial Agents - therapeutic use ; Antibiotic Prophylaxis ; Bacterial Infections - prevention &amp; control ; Biological and medical sciences ; Cefazolin - therapeutic use ; Central Nervous System Neoplasms - surgery ; Clindamycin - therapeutic use ; Craniotomy - methods ; Encephalocele - surgery ; endoscopic skull base surgery ; Endoscopy - methods ; Gentamicins - therapeutic use ; Humans ; Intraoperative Complications ; Medical sciences ; Otorhinolaryngology. Stomatology ; perioperative care ; pituitary surgery ; Postoperative Care ; postoperative infection ; Preoperative Care ; Prophylactic antibiotics ; Prospective Studies ; Skull Base - surgery ; Subdural Effusion ; Surgical Wound Infection - prevention &amp; control ; Vancomycin - therapeutic use</subject><ispartof>The Laryngoscope, 2007-09, Vol.117 (9), p.1528-1532</ispartof><rights>Copyright © 2007 The Triological Society</rights><rights>2007 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4964-4482cc137d2add2913cbd7e8e7eff339178590715d5608a2c5d65f00ec101623</citedby><cites>FETCH-LOGICAL-c4964-4482cc137d2add2913cbd7e8e7eff339178590715d5608a2c5d65f00ec101623</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1097%2FMLG.0b013e3180caa177$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1097%2FMLG.0b013e3180caa177$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=19061360$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17667141$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brown, Seth M.</creatorcontrib><creatorcontrib>Anand, Vijay K.</creatorcontrib><creatorcontrib>Tabaee, Abtin</creatorcontrib><creatorcontrib>Schwartz, Theodore H.</creatorcontrib><title>Role of Perioperative Antibiotics in Endoscopic Skull Base Surgery</title><title>The Laryngoscope</title><addtitle>The Laryngoscope</addtitle><description>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. 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Stomatology</subject><subject>perioperative care</subject><subject>pituitary surgery</subject><subject>Postoperative Care</subject><subject>postoperative infection</subject><subject>Preoperative Care</subject><subject>Prophylactic antibiotics</subject><subject>Prospective Studies</subject><subject>Skull Base - surgery</subject><subject>Subdural Effusion</subject><subject>Surgical Wound Infection - prevention &amp; control</subject><subject>Vancomycin - therapeutic use</subject><issn>0023-852X</issn><issn>1531-4995</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkEtv00AURkcIREPhHyDkDexc7p2nZ0dSlYCUAkor8diMJuNrNNSx0xkbyL_HVSIqsWJ1N-c7VzqMPUc4Q7Dm9eVqeQYbQEECKwjeozEP2AyVwFJaqx6yGQAXZaX4lxP2JOcfAGiEgsfsBI3WBiXO2GLdt1T0TfGJUux3lPwQf1Ix74a4if0QQy5iV1x0dZ9Dv4uhuLoZ27ZY-EzF1Zi-U9o_ZY8a32Z6dryn7PrtxfX5u3L1cfn-fL4qg7RallJWPAQUpua-rrlFETa1oYoMNY0QFk2lLBhUtdJQeR5UrVUDQAEBNRen7NVBu0v97Uh5cNuYA7Wt76gfs9OV5JbzO1AewJD6nBM1bpfi1qe9Q3B36dyUzv2bbpq9OPrHzZbq-9Gx1QS8PAI-B982yXch5nvOgkahYeLeHLhfsaX9fz13q_n6q1IS0YAFOSnKgyLmgX7_Vfh047QRRrnPH5bOfltjdblcu4X4A9jHmPk</recordid><startdate>200709</startdate><enddate>200709</enddate><creator>Brown, Seth M.</creator><creator>Anand, Vijay K.</creator><creator>Tabaee, Abtin</creator><creator>Schwartz, Theodore H.</creator><general>John Wiley &amp; Sons, Inc</general><general>Wiley-Blackwell</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>8BM</scope></search><sort><creationdate>200709</creationdate><title>Role of Perioperative Antibiotics in Endoscopic Skull Base Surgery</title><author>Brown, Seth M. ; Anand, Vijay K. ; Tabaee, Abtin ; Schwartz, Theodore H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4964-4482cc137d2add2913cbd7e8e7eff339178590715d5608a2c5d65f00ec101623</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Antibiotic Prophylaxis</topic><topic>Bacterial Infections - prevention &amp; control</topic><topic>Biological and medical sciences</topic><topic>Cefazolin - therapeutic use</topic><topic>Central Nervous System Neoplasms - surgery</topic><topic>Clindamycin - therapeutic use</topic><topic>Craniotomy - methods</topic><topic>Encephalocele - surgery</topic><topic>endoscopic skull base surgery</topic><topic>Endoscopy - methods</topic><topic>Gentamicins - therapeutic use</topic><topic>Humans</topic><topic>Intraoperative Complications</topic><topic>Medical sciences</topic><topic>Otorhinolaryngology. Stomatology</topic><topic>perioperative care</topic><topic>pituitary surgery</topic><topic>Postoperative Care</topic><topic>postoperative infection</topic><topic>Preoperative Care</topic><topic>Prophylactic antibiotics</topic><topic>Prospective Studies</topic><topic>Skull Base - surgery</topic><topic>Subdural Effusion</topic><topic>Surgical Wound Infection - prevention &amp; control</topic><topic>Vancomycin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brown, Seth M.</creatorcontrib><creatorcontrib>Anand, Vijay K.</creatorcontrib><creatorcontrib>Tabaee, Abtin</creatorcontrib><creatorcontrib>Schwartz, Theodore H.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>ComDisDome</collection><jtitle>The Laryngoscope</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brown, Seth M.</au><au>Anand, Vijay K.</au><au>Tabaee, Abtin</au><au>Schwartz, Theodore H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of Perioperative Antibiotics in Endoscopic Skull Base Surgery</atitle><jtitle>The Laryngoscope</jtitle><addtitle>The Laryngoscope</addtitle><date>2007-09</date><risdate>2007</risdate><volume>117</volume><issue>9</issue><spage>1528</spage><epage>1532</epage><pages>1528-1532</pages><issn>0023-852X</issn><eissn>1531-4995</eissn><coden>LARYA8</coden><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. 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subjects Anti-Bacterial Agents - therapeutic use
Antibiotic Prophylaxis
Bacterial Infections - prevention & control
Biological and medical sciences
Cefazolin - therapeutic use
Central Nervous System Neoplasms - surgery
Clindamycin - therapeutic use
Craniotomy - methods
Encephalocele - surgery
endoscopic skull base surgery
Endoscopy - methods
Gentamicins - therapeutic use
Humans
Intraoperative Complications
Medical sciences
Otorhinolaryngology. Stomatology
perioperative care
pituitary surgery
Postoperative Care
postoperative infection
Preoperative Care
Prophylactic antibiotics
Prospective Studies
Skull Base - surgery
Subdural Effusion
Surgical Wound Infection - prevention & control
Vancomycin - therapeutic use
title Role of Perioperative Antibiotics in Endoscopic Skull Base Surgery
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