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J Neurol Surg B Skull Base 2022; 83(06): 579-588
DOI: 10.1055/a-1865-3202
Review Article

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 
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
Stephen E. Sullivan
1   Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States
,
Emily Bellile
2   Cancer Data Science, Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, United States
,
Christopher Roxbury
3   Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, Illinois, United States
,
Paramita Das
4   Department of Neurosurgery, University of Chicago, Chicago, Illinois, United States
,
Ralph Abi Hachem
5   Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
,
Feras Ackall
5   Department of Head and Neck Surgery and Communication Sciences, Duke University, Durham, North Carolina, United States
,
David Jang
6   Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
,
Emrah Celtikci 
6   Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
,
Muammer Melih Sahin
7   Department of Otolaryngology–Head and Neck Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
,
Glen D'souza
8   Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
James J. Evans
9   Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Gurston Nyquist
8   Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Adham Khalafallah
10   Department of Neurosurgery, University of Miami/Jackson Health System, Miami, Florida, United States
,
Debraj Mukherjee 
11   Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
,
Nicholas R. Rowan 
12   Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland, United States
,
Samantha Camp
11   Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, United States
,
Garret Choby
13   Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Jamie J. Van Gompel 
14   Department of Neurosurgery and Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, United States
,
Michael K. Ghiam
15   Department of Otolaryngology, University of Miami, Miami, Florida, United States
,
Corinna G. Levine
15   Department of Otolaryngology, University of Miami, Miami, Florida, United States
,
Melvin Field
16   Orlando Neurosurgery, Orlando, Florida, United States
,
Nithin Adappa
17   Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Tran B. Locke
18   Department of Otolaryngology–Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
,
Christopher Rassekh
17   Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
,
Auddie M. Sweis
19   Division of Otolaryngology–Head and Neck Surgery, Northshore University Health System, University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States
,
Neerav Goyal 
20   Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Brad Zacharia
21   Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Meghan N. Wilson
20   Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Shivam Patel
20   Department of Otolaryngology–Head and Neck Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
,
Paul A. Gardner
22   Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Carl H. Snyderman
23   Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Eric W. Wang
23   Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
,
Laurence Johann Glancz
24   Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
25   Manchester Skullbase Unit, Salford Royal Hospital, Manchester, United Kingdom
,
Ananyo Bagchi
24   Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
,
Graham Dow
24   Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
,
Iain Robertson
24   Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
,
Sanjeet V. Rangarajan
26   Department of Otolaryngology, Head-Neck Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
L. Madison Michael II
27   Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Erin L. McKean
28   Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, United States
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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.

Keywords

surgical site infections - pituitary adenomas - endonasal approach - antibiotics


Publication History

Received: 19 December 2021

Accepted: 26 May 2022

Accepted Manuscript online:
31 May 2022

Article published online:
25 August 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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