Prevention of and Countermeasures for Surgical Site Infection in the Field of Skull Base Surgery

Abstract

In neurosurgery, perioperative surgical site infection(SSI)is associated with complicated postoperative management, prolonged hospital stay, and patient stress. In this article, we review SSI in the field of skull base surgery, including endoscopic endonasal surgery, and discuss ways to prevent SSI. In a craniotomy, in which the frontal sinus is revealed, prevention of cerebrospinal fluid(CSF)leakage by reliable repair of the dura and frontal sinus reduces SSI. In addition, prevention of postoperative CSF leakage by reliable skull base reconstruction in endoscopic endonasal surgery contributes to the prevention of SSI. Prophylactic antibiotics are often reported to be useful, and cephalosporin or sulbactam/ampicillin intravenous injections are generally used. There are insufficient data to recommend lumbar drainage for the management of SSI and postoperative CSF leak. Skull base surgery is often a clean-contaminated surgery, and serious complications can be prevented by proper understanding and performance of the appropriate method as required. However, no studies with a high level of evidence on SSI in the field of skull base surgery exist. New large randomized controlled trials are expected to evaluate the efficacy of prophylactic antibiotics in skull base surgery.