Clinical Study Of Intracranial Infection After Endoscopic Endonasal Skull Base Surgery

Objectives:The nasal endoscopic technology is a revolution in the field of nasal surgery, as the technology has become increasingly perfect and mature, nasal endoscopic surgery for nasal surgery from pure nasal surgery gradually to the base of skull, a growing number of skull base lesions can be finished by nasal endoscopic surgery. Transnasal endoscopic cranial-base approach compared with the traditional surgical operation, with the advantages of small incision, increasingly more and more common in clinical, meanwhile complications of nasal endoscopic skull base surgery in clinic are more, the postoperative intracranial infection is one of the more common. The purpose of this study is mainly to analyze the postoperative intracranial infection factors of the transnasal endoscopic cranial-base approach.Methods:There are 563 patients with nasal endoscopic skull base surgery in the otolaryngology head and neck surgery of Tianjin Huanhu Hospital from 1999 to 2014,including 227 cases of skull base tumor, 278 patients with cerebrospinal fluid leak, 22 cases of meningo-encephalocele, 24 cases of optic canal decompression and 12 patients with empty sella. The skull base tumors, mainly including pituitary adenoma, schwannoma,meningioma, craniopharyngioma, esthesioneuroblastoma, chordoma, etc. The clinical data of 563 patients were summarized, and the factors associated with intracranial infection are the single factor analysis and multivariable Logistic regression analysis. Factors will be significant to calculate odds ratios(OR), with p<0.05 as the statistical significance.Results: Of the 563 patients, 32 cases of patients with postoperative infection(5.68%);postoperative cerebrospinal fluid leak, the reconstruction of the skull base after surgery, history of skull base surgery, diabetes is the independent risk factors of postoperative intracranial infection, postoperative cerebrospinal fluid leak is the highest independent risk factors of postoperative intracranial infection(OR= 7.76),preoperative preventive use of antibiotics is the only protective factors(OR = 0.31), while age, sex, hypertension, artificial materials, postoperative using of antimicrobial drugs > 7 d is not obvious effect on postoperative intracranial infection, there was no statistically significant difference.Conclusions:1.Postoperative intracranial infection of nasal endoscopic skull base surgery can be caused by a single factor or multiple factors, in this study the postoperativecerebrospinal fluid leakage, skull base reconstruction after surgery, diabetes, history of skull base surgery are independent risk factors of postoperative intracranial infection.2. Postoperative cerebrospinal fluid leak is the highest independent risk factors of postoperative intracranial infection(OR= 7.76), preoperative preventive use of antibiotics are protective factors(OR = 0.31).3. Long-term use of antibiotics after surgery(> 7 days) does not reduce postoperative intracranial infection, and could lead to multiple drug-resistant bacteria, increase difficulty of treatment.4. Intracranial infection rate after endoscopic endonasal skull base surgery is low, once diagnosed, should immediately give the anti infection treatment.