One Thousand Endoscopic Skull Base Surgical Procedures Demystifying the Infection Potential: Incidence and Description of Postoperative Meningitis and Brain Abscesses

Abstract

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 = .003), surgerywith higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70];P = .005), 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 = .04), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P<.001) were risk factors for infection.Conclusion.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.