Impact of Intraoperative Disinfection on Postoperative Intracranial Infection in TESBS

Overview

This retrospective study of 1002 patients undergoing transnasal endoscopic skull base surgery (TESBS) compared routine versus multiple intraoperative disinfection methods. Multiple disinfection significantly reduced postoperative intracranial infection rates from 5.72% to 2.20%. Bacteriological surveillance demonstrated that repeated disinfection decreased nasal colonizing bacteria, correlating with lower infection incidence.

Background

Transnasal endoscopic skull base surgery is widely used for various skull base tumors due to its minimally invasive approach. However, the surgical pathway traverses bacterial-rich nasal and sinus cavities, increasing the risk of postoperative intracranial infections, which range from 0.8% to 7.98% in reported studies. Common pathogens include colonizing bacteria such as Streptococcus pneumoniae and Staphylococcus epidermidis. Effective intraoperative disinfection strategies may reduce these infections and improve patient outcomes.

Data Highlights

Key Findings

• Routine disinfection involved a single preoperative nasal cavity iodine application, while multiple disinfection included repeated iodine applications at key surgical stages.
• Postoperative intracranial infection rate was significantly lower in the multiple disinfection group (2.20%) compared to routine disinfection (5.72%).
• Intraoperative bacteriological surveillance showed a reduction in colonizing bacteria after multiple disinfection steps.
• CSF leakage was identified as a major risk factor for intracranial infection, but multiple disinfection reduced infection rates regardless of leakage status.
• Pathogenic bacteria isolated from infections included common nasal colonizers such as Streptococcus pneumoniae and Staphylococcus epidermidis.

Clinical Implications

Implementing multiple intraoperative disinfection steps during TESBS can significantly reduce postoperative intracranial infection rates by effectively decreasing bacterial colonization in the nasal and sinus cavities. Surgeons should consider adopting repeated disinfection protocols at critical operative stages to improve patient safety. Additionally, vigilant monitoring and management of CSF leaks remain essential to minimize infection risk.

Conclusion

Multiple intraoperative disinfection methods during TESBS are associated with a marked reduction in postoperative intracranial infections. These findings support the adoption of enhanced disinfection protocols to improve surgical outcomes in skull base surgery.

References

1. Nanchang University Neurosurgery Department, 2016-2024 -- Impact of Disinfection on Intracranial Infection Rates in TESBS