Systematic Review of the Effectiveness of Perioperative Prophylactic Antibiotics for Skull Base Surgeries

Rosen, Sheri; Getz, Anne E.; Kingdom, Todd T.; Youssef, A. Samy; Ramakrishnan, Vijay R.

doi:10.2500/ajra.2016.30.4298

Cited by 24 publications

(24 citation statements)

References 42 publications

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“…Scant literature exists regarding antibiotic prophylaxis in ESBS and no existing data suggest the superiority of one regimen over another in ESBS. [28][29][30][31] Regardless of antibiotic choice, infectious complications such as meningitis remain rare and are associated with postoperative CSF leak. 28,29,32 One prior study suggested 24 to 48 hours of a single agent covering gram-positive organisms.…”

Section: Discussionmentioning

confidence: 99%

“…[28][29][30][31] Regardless of antibiotic choice, infectious complications such as meningitis remain rare and are associated with postoperative CSF leak. 28,29,32 One prior study suggested 24 to 48 hours of a single agent covering gram-positive organisms. 32 Another study recommended two doses of cefuroxime was adequate for transsphenoidal surgery.…”

Section: Discussionmentioning

confidence: 99%

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Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Wannemuehler

Rabbani

Burgeson

et al. 2018

Laryngoscope Investig Oto

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BackgroundEndoscopic skull base surgery (ESBS) is a rapidly expanding field. Despite divergent reported preferences for reconstructive techniques and perioperative management, limited data exist regarding contemporary practice patterns among otolaryngologists performing ESBS. This study aims to elucidate current practice patterns, primarily the volumes of cases performed and secondarily a variety of other perioperative preferences.MethodsAn anonymous 32‐item electronic survey examining perioperative ESBS preferences was distributed to the American Rhinologic Society membership. Statistical significance between variables was determined utilizing Student t, chi‐square, and Fisher exact tests.ResultsSeventy otolaryngologists completed the survey. The effective response rate was approximately 22.5%. Sixty percent of respondents were in full‐time academic practice and 70% had completed rhinology/skull base fellowships. Annually, 43.3 mean ESBS cases were performed (29.1 private practice vs. 52.9 academic practice, P = .009). Academic practice averaged 24.1 expanded cases versus only 11 in private practice (P = .01). Of respondents, 55.7% stood on the same side as the neurosurgeon and 72.9% remained present for the entire case. Current procedural terminology coding and antibiotic regimens were widely divergent; 31.4% never placed lumbar drains preoperatively, while 41.4% did so for anticipated high‐flow cerebrospinal fluid leaks. While considerable variation in reconstructive techniques were noted, intradural defect repairs utilized vascularized flaps 86.3% of the time versus only 51.3% for extradural repairs (P < 0.001). Major complications were rare. Postoperative restrictions varied considerably, with most activity limitations between 2–8 weeks and positive airway pressure use for 2–6 weeks. Most respondents started saline irrigations 0–2 weeks postoperatively.ConclusionsBased on responses from fellowship‐ and non‐fellowship‐trained otolaryngologists in various practice settings, there remains considerable variation in the perioperative management of patients undergoing ESBS.Level of Evidence5

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Wannemuehler

Rabbani

Burgeson

et al. 2018

Laryngoscope Investig Oto

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“…Additionally, the use of nasal packing was not assessed as an independent factor for outcomes including infectious complications. The 2016 systematic review by Rosen et al . did not find any evidence linking the use of nasal packing or the duration of nasal packing to infectious complications or duration of antibiotics.…”

Section: Intraoperative Considerationsmentioning

confidence: 98%

“…Two of the studies did not have exclusion criteria, the other 2 studies excluded patients felt to be at elevated risk of postoperative complications . In addition, there was a systematic review of open, microscopic, and endoscopic approaches to the skull base, which included the studies listed here that had been published at that time . However, the authors were not able to perform a meta‐analysis given the heterogeneity of the studies.…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

150

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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“…Miller et al 12 review data that analyzes the impact of middle turbinate resection on bleeding after ESS and conclude that there is no change in major bleeding risk but that patients on anticoagulants are at an increased risk of minor bleeds after surgery. Rosen et al 13 conducted a systematic review of antibiotic use in endoscopic skull base surgery and show that, in general, meningitis is exceedingly rare in endoscopic relative to open procedures. The article by Zelenik et al 14 adds to the ongoing controversy regarding the association between esophageal reflux and CRS.…”

mentioning

confidence: 99%

Inverted Papilloma: The Stubbornly Persistent Tumor of the Sinonasal Cavity

Rotenberg¹

2016

Am J Rhinol�Allergy

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Systematic Review of the Effectiveness of Perioperative Prophylactic Antibiotics for Skull Base Surgeries

Cited by 24 publications

References 42 publications

Survey of endoscopic skull base surgery practice patterns among otolaryngologists

Survey of endoscopic skull base surgery practice patterns among otolaryngologists

ICAR: endoscopic skull‐base surgery

Inverted Papilloma: The Stubbornly Persistent Tumor of the Sinonasal Cavity

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