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Updated: Feb 26, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Antibiotic Prophylaxis in Endoscopic Endonasal Pituitary and Skull Base Surgery
Laura Milanese1, Matteo Zoli1, Giacomo Sollini2
1Center of Surgery for Pituitary Tumors and Endoscopic Skull Base Surgery, Department of Neurosurgery, Istituto di Ricovero e Cura a Carattere Scientifico - Istituto delle Scienze Neurologiche, Bologna, Italy.
Objective:
Postoperative infection is a potentially dramatic consequence in endoscopic endonasal surgery. The aim of this study was to assess the efficacy of our intraoperative antibiotic prophylaxis by analyzing the risk factors of postoperative meningitis in our series.
Methods:
Each endoscopic endonasal procedure performed since 1998 in patients with no preoperative infections and a follow-up longer than 30 days were included and retrospectively reviewed. Antibiotic protocol consisted in single antibiotic administration of ampicillin/sulbactam 3 g or cefazolin 2 g on induction; no postoperative administrations were performed after 2005. All cases of cerebrospinal fluid (CSF) leak, meningitis, and systemic infection were recorded.
Results:
Two thousand thirty-two procedures matched the inclusion criteria (median age 50 years; range: 1-89 years, male/female ratio: 1:1.12). Intraoperative CSF leak occurred in 32.8% of the cases and postoperative CSF leak in 3.4%. The rate of meningitis was 0.69%; other systemic infections were observed in 0.44% of cases. Meningitis was statistically associated with intra- and postoperative CSF leak (P < 0.001). Other risk factors were the intradural extension of the tumors and their malignant histology. Extended approaches producing wide osteodural defects were correlated with a greater risk of meningitis (P < 0.001).
Conclusions:
All surgical maneuvers to prevent, detect, and quickly repair intra- and postoperative CSF leak are crucial to avoid postoperative meningitis. The proposed prophylaxis protocol is comparable in safety to those recommended in literature as assessed by the low rate of meningitis.
Insights
This study evaluated antibiotic prophylaxis for endoscopic endonasal surgery, finding that preventing cerebrospinal fluid (CSF) leaks is crucial for avoiding postoperative meningitis. The antibiotic protocol demonstrated safety comparable to existing recommendations.
Area of Science:
- Neurosurgery
- Infectious Disease
- Surgical Oncology
Background:
- Postoperative infection, particularly meningitis, poses a significant risk following endoscopic endonasal surgery.
- Understanding risk factors associated with meningitis is essential for optimizing patient outcomes.
Purpose of the Study:
- To assess the efficacy of intraoperative antibiotic prophylaxis in preventing postoperative meningitis.
- To identify risk factors contributing to meningitis after endoscopic endonasal procedures.
Main Methods:
- Retrospective review of 2,032 endoscopic endonasal procedures performed since 1998 with follow-up >30 days.
- Analysis of antibiotic prophylaxis protocols (ampicillin/sulbactam or cefazolin) and recording of cerebrospinal fluid (CSF) leaks and infections.
- No postoperative antibiotic administrations were used after 2005.
Main Results:
- The overall meningitis rate was 0.69%, with other systemic infections at 0.44%.
- Intraoperative (32.8%) and postoperative (3.4%) CSF leaks were strongly associated with meningitis (P < 0.001).
- Tumor intradural extension, malignant histology, and wide osteodural defects increased meningitis risk.
Conclusions:
- Preventing, detecting, and repairing CSF leaks are paramount in avoiding postoperative meningitis.
- The evaluated antibiotic prophylaxis protocol is safe and comparable to current literature standards, evidenced by a low meningitis rate.
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