Risk Factors for Intracranial Infection in Surgical Patients with Suprasellar Craniopharyngiomas by an Expanded Endoscopic Endonasal Approach: A Single-Center Initial Experience

Abstract

Objective

To explore the risk factors for intracranial infection in surgical patients with suprasellar craniopharyngiomas by an expanded endoscopic endonasal approach (EEEA) in a single center.

Methods

Forty-one patients with suprasellar craniopharyngiomaswere retrospectively recruited. EEEA was applied in all patients. All patients were evaluated for the occurrence of intracranial infection after surgery, and the risk factors of infection were further analyzed. The databases of PubMed and Web of Science were systematically reviewed to identify the rate of meningitis with suprasellar craniopharyngiomas treated with extended endoscopic endonasal transsphenoidal surgery (EETS).

Results

Intracranial infection occurred in 21.95% of patients. Patients who were diagnosed as recurrent tumor presented with significant higher incidence of infection than that in the patients with first surgery (55.56% vs. 18.75%; P < 0.05). The rate of the third ventricle exposure was 88.89% in 9 infected patients, which was significantly higher than 40.63% in uninfected patients (P < 0.05). The risk factor for postsurgery infection was the exposure of third ventricle during surgery (P = 0.043; odds ratio = 10.374). The incidence of EETS meningitis varies from 0% to 30%, and the rate of cerebrospinal fluid leak varies from 0% to 58% in previous studies. Twenty three patients received gentamicin physiological saline irrigation in our study, and only 2 presented intracranial infection after surgery.

Conclusions

The rate of EETS meningitis varies from 0% to 30% according to previous studies. Opening of the third ventricle during surgery was an independent risk factor for intracranial infection in surgical patients with suprasellar craniopharyngiomas by EEEA. Gentamicin physiological saline irrigation during surgery might prevent postsurgical infection.