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  • Is Antibiotics Needed for Endoscopic Endonasal Transphenoidal Surgery for Pituitary Tumors: A Well Design Systematic Review and Meta- Analysis

    Final Number:

    Fahad A. Alkherayf MD MSc CIP FRCSC; Ioana Moldovan MD, MSc; Idara John Edem H.BSc, MD; Mary-Anne Doyle MD, MSc, FRCPC; Erin Keely MD, FRCP; Charles B. Agbi MD, FRCSC; Shaun Kilty

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: The benefit of prophylactic antibiotic use in endoscopic endonasal transsphenoidal surgery for pituitary lesions is controversial. Many surgeons administer antibiotics perioperatively not based on clear guidelines but “to be safe”. Also there is no clear evidence on what is the right antibiotics.Our goal is to to determine if the antibiotic prophylaxis use reduces the risk of infection (e.g., meningitis, sinusitis) within 30 days after the surgery, in adult patients with pituitary lesions undergoing EETS.

    Methods: A systematic review using PRISMA guidelines was performed to assess the efficacy of perioperative antibiotic use to prevent infectious complications in patients undergoing EETS. Inclusion criteria: randomized controlled trials including two or more groups comparing antibiotic-placebo or antibiotic-antibiotic use perioperatively for EETS, systematic reviews with/without meta-analysis, observational studies, and case series of prophylactic antibiotic perioperative use for EETS. The following data were extracted from each study included into the systematic review: study design, year of publication, sample size, surgery type, perioperative antibacterial treatment (antibiotic, dose, duration), number of patients with 30-days post-operative meningitis and/or sinusitis. End points: rates of meningitis and sinusitis as infectious complications after EETS.

    Results: A total of 280 articles were identified by the initial search. Four studies met the inclusion criteria: three retrospective descriptive cohort studies and one prospective case series study. Total of 633 patients were included in our analysis. The study participants received different antibiotic regimens perioperatively. The most common used antibiotics are cefazoline and ceftazidime . The rate of infection ranged from 0.5% to 3.1 % with meningitis is the most common infection. Based on GRADE score these studies were considered low in quality, however it seems that cefazoline (1 gram every 8 hourse) is the most effective prophylactic antibiotics.

    Conclusions: The need to use antibiotic(s) perioperatively is still not clear in patients with pituitary lesions undergoing EETS, however our study showed that cefazoline might be the right antibiotics.

    Patient Care: by reviewing neurosurgery current practice in pituitary surgery

    Learning Objectives: 1- to evaluate the need for prophylactic antibiotics in pituitary surgery.


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