Analysis Of The Risk Factors Of Central Nervous System Infection After Neuroendoscopic Transsphenoidal Sellar Mass Resection Surgery

ObjectiveWith the increasing popularity of clinical examination equipment such as CT and MRI in recent years,occupying lesions in the sellar region,including pituitary adenoma,craniopharyngioma,Rathke’s cleft cyst,meningioma,and other diseases,can be detected at an early stage,and receive timely treatment.The endoscopic endonasal transsphenoidal approach(EETA)has become the first choice for the treatment of sellarmasses because of its minimally invasive,direct visualization,multiple working angles,and high resection rate,and is generally accepted by patients.However,because of the dense distribution of important anatomical structures such as the sellar diaphragm,pituitary gland,blood vessels,and nerves in the sellar region,there is a risk of various postoperative complications including hypopituitarism,diabetes insipidus,optic nerve injury,injury to the internal carotid artery and its branches,and cerebrospinal fluid leakage.Intracranial infection is a serious postoperative complication in neurosurgery,especially in the sellar region,which is a narrow but critical anatomical area that can have more serious consequences after intracranial infection,significantly prolonging the patient’s hospital stay and increasing the risk of death.MethodsBy retrospectively analyzing the clinical information of 238 patients with occupying lesions in sellar region who underwent neuroendoscopic transsphenoidal sellar mass resection surgery admitted to our neurosurgical oncology ward from January2019 to December 2020,including gender,age,history of underlying diseases such as hypertension and diabetes,history of neurosurgery,preoperative imaging sinusitis manifestations,postoperative pneumocephalus,postoperative intracranial hemorrhage,maximum tumor diameter,preoperative prophylactic antibiotics,duration of surgery,intraoperative cerebrospinal fluid leak,amount of intraoperative bleeding,postoperative cerebrospinal fluid leak,postoperative nasal bleeding,perioperative lumbar/extraventricular drainage,intraoperative skull base reconstruction,and preoperative tumor stroke,patients were divided into infected and uninfected groups according to whether intracranial infection occurred after surgery,and the data of both groups were statistically analyzed using SPSS Statistics 26.0 software.A univariate analysis was first performed,and the differential indicators with P < 0.05 in the analysis results were selected for subsequent inclusion in a multifactorial logistic regression analysis,so as to determine the independent risk factors for the occurrence of intracranial infection after neuroendoscopic transsphenoidal sellar mass resection surgery,and P < 0.05 was considered statistically significant in this study.ResultsOf 238 patients who underwent neuroendoscopic transsphenoidal sellar mass resection surgery,19 developed postoperative intracranial infections,including 2 growth hormone cell adenomas,3 prolactin cell adenomas,1 adrenocorticotropic cell adenoma,3 gonadotropin cell adenomas,4 zero cell adenomas,1 pituitary cell tumor,1 Rathke’s cleft cyst,3 adamantinomatous craniopharyngioma,and there was one case of osteofibrous dysplasia.Postoperative cerebrospinal fluid culture results were positive in7 cases,with a positive detection rate of 36.8%.Univariate analysis showed that,maximum lesion diameter ≥4 cm,duration of surgery ≥4 h,intraoperative cerebrospinal fluid leak,postoperative cerebrospinal fluid leak,perioperative extraventricular/lumbar drainage,intraoperative skull base reconstruction,postoperative intracranial pneumocephalus,and postoperative intracranial hemorrhage were significantly associated with the occurrence of intracranial infection after EETA(all with P < 0.05).The results of multifactorial logistic regression analysis showed that postoperative cerebrospinal fluid leak and postoperative intracranial hemorrhage were independent risk factors for the development of intracranial infection after EETA(all P < 0.05).Conclusion1.For those who need to undergo EETA treatment,cases with large lesion volume and significant occupying effect,intraoperative and postoperative cerebrospinal fluid leakage,perioperative use of lumbar/extraventricular drainage,intraoperative skull base reconstruction,and postoperative cranial CT revealing pneumocephalus and intracranial hemorrhage,more attention should be paid to the prevention of postoperative intracranial infection during the patient’s hospitalization,and regular postoperative observation of the patient’s vital signs.If there is a high suspicion of postoperative intracranial infection,cerebrospinal fluid specimens should be sent for examination and upgrade of antibiotics in a timely manner.2.Postoperative cerebrospinal fluid leak and postoperative intracranial hemorrhage are independent risk factors for intracranial infection after EETA.In clinical practice,if the above two conditions occur,they should be highly valued by clinicians and timely remedial measures should be taken,such as repair of the cerebrospinal fluid leak or intracranial hematoma removal for symptomatic treatment.3.Since EETA is performed through a non-sterile nasal cavity,there is a high risk of postoperative intracranial infection,and intracranial infection in the sellar region often causes serious consequences.Therefore,more attention must be paid to the prevention of the above risk factors during the treatment of patients,and antibiotic therapy can be used prophylactically during the perioperative period to fully reduce the risk of intracranial infection after EETA.