頭蓋底外科領域におけるSSIとその予防・対策

Prevention of and Countermeasures for Surgical Site Infection in the Field of Skull Base Surgery

Point

・頭蓋底手術は準清潔手術になる場合も少なくなく，必要に応じた適切な対処方法を正しく理解し，遂行することで重大な合併症を防ぐことができる．

・前頭洞が開放される開頭術では，硬膜の確実な修復による髄液漏の阻止と，前頭洞の閉鎖がSSIを軽減する．

・経鼻内視鏡手術において髄液漏はSSIの危険因子であり，確実な鞍底再建による術後髄液漏の防止がSSIを軽減する．

　In neurosurgery, perioperative surgical site infection（SSI）is associated with complicated postoperative management, prolonged hospital stay, and patient stress. In this article, we review SSI in the field of skull base surgery, including endoscopic endonasal surgery, and discuss ways to prevent SSI. In a craniotomy, in which the frontal sinus is revealed, prevention of cerebrospinal fluid（CSF）leakage by reliable repair of the dura and frontal sinus reduces SSI. In addition, prevention of postoperative CSF leakage by reliable skull base reconstruction in endoscopic endonasal surgery contributes to the prevention of SSI. Prophylactic antibiotics are often reported to be useful, and cephalosporin or sulbactam/ampicillin intravenous injections are generally used. There are insufficient data to recommend lumbar drainage for the management of SSI and postoperative CSF leak. Skull base surgery is often a clean-contaminated surgery, and serious complications can be prevented by proper understanding and performance of the appropriate method as required. However, no studies with a high level of evidence on SSI in the field of skull base surgery exist. New large randomized controlled trials are expected to evaluate the efficacy of prophylactic antibiotics in skull base surgery.