Retrospective Review of Surgical Site Infections after Endoscopic Endonasal Sellar and Parasellar Surgery: Multicenter Quality Data from the North American Skull Base Society

Sara Saleh, Stephen E. Sullivan, Emily Bellile, Christopher Roxbury, Paramita Das, Ralph Abi Hachem, Feras Ackall, David Jang, Emrah Celtikci, Muammer Melih Sahin, Glen D'Souza, James J. Evans, Gurston Nyquist, Adham Khalafallah, Debraj Mukherjee, Nicholas R. Rowan, Samantha Camp, Garret Choby, Jamie J.Van Gompel, Michael K. GhiamCorinna G. Levine, Melvin Field, Nithin Adappa, Tran B. Locke, Christopher Rassekh, Auddie M. Sweis, Neerav Goyal, Brad Zacharia, Meghan N. Wilson, Shivam Patel, Paul A. Gardner, Carl H. Snyderman, Eric W. Wang, Laurence Johann Glancz, Ananyo Bagchi, Graham Dow, Iain Robertson, Sanjeet V. Rangarajan, L. Madison Michael, Erin L. McKean

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction Transnasal access to the anterior skull base provides a minimally invasive approach for sellar and parasellar masses compared with its open counterparts. The unique microbiome of the sinonasal mucosa provides distinct challenges not encountered with other cranial approaches. The use of antibiotics in these cases has not been standardized, and data remain scarce regarding infectious outcomes. Methods We conducted a multicenter retrospective analysis of shared quality data points for the endoscopic endonasal approach (EEA) for pituitary adenomas, along with other sellar and parasellar region masses that were included by participating institutions. Patient and operative characteristics, perioperative and postoperative antibiotic regimens and their durations, intraoperative and postoperative cerebrospinal fluid leak, and onset of postoperative meningitis and sinusitis were compared. Results Fifteen institutions participated and provided 6 consecutive months' worth of case data. Five hundred ninety-three cases were included in the study, of which 564 were pituitary adenomectomies. The incidences of postoperative meningitis and sinusitis were low (0.67 and 2.87% for all pathologies, respectively; 0.35% meningitis for pituitary adenomas) and did not correlate with any specific antibiotic regimen. Immunocompromised status posed an increased odds of meningitis in pituitary adenomectomies (28.6, 95% confidence interval [1.72-474.4]). Conclusions The results show no clear benefit to postoperative antimicrobial use in EEA, with further larger studies needed.

Original languageEnglish (US)
JournalJournal of Neurological Surgery, Part B: Skull Base
DOIs
StateAccepted/In press - 2022

Keywords

  • antibiotics
  • endonasal approach
  • pituitary adenomas
  • surgical site infections

ASJC Scopus subject areas

  • Clinical Neurology

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