Management and outcomes in children with sinogenic intracranial abscesses

• Published in: International journal of pediatric otorhinolaryngology Vol. 79; no. 6; pp. 868 - 873
• Main Authors: Patel, Anant P, Masterson, Liam, Deutsch, Christopher J, Scoffings, Daniel J, Fish, Brian M
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.06.2015
• Subjects: Adolescent; Anti-Infective Agents - therapeutic use; Aphasia, Broca - microbiology; Brain abscess; Brain Abscess - diagnostic imaging; Brain Abscess - etiology; Brain Abscess - therapy; Child; Child Behavior Disorders - microbiology; Cognition Disorders - microbiology; Complicated sinusitis; Consciousness Disorders - microbiology; Drainage; Empyema, Subdural - diagnostic imaging; Empyema, Subdural - etiology; Empyema, Subdural - therapy; Female; Humans; Intracranial abscess; Male; Otolaryngology; Paediatric sinogenic abscess; Paresis - microbiology; Pediatrics; Retrospective Studies; Sinusitis - complications; Sinusitis - surgery; Tomography, X-Ray Computed; Brain abscess; Complicated sinusitis; Intracranial abscess; Paediatric sinogenic abscess
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2015.03.020

Abstract Objective To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. Methods All children with sinogenic intracranial abscesses presenting to a large university teaching hospital over a five-year period were included in the study. Data on clinical presentation, radiological findings, microbiology, medical and surgical management and follow-up were recorded and analysed. Results We identified 27 children aged 12.9 ± 3.4 years of which 56% were male. Fourteen (52%) children had extradural abscesses, nine (33%) subdural abscesses and four (15%) parenchymal abscesses. Early sinus drainage procedures were performed on 24 (89%) patients, and the same number required neurosurgical drainage. Streptococcus milleri was isolated in 18 (67%) cases. An initial conservative neurosurgical approach failed in 50% of cases where trialled, and was associated with longer length of stay ( p = 0.025). In comparison to extradural abscesses, subdural abscesses were more likely to present with neurological deficits ( p < 0.001) and reduced consciousness ( p = 0.018), and required multiple neurosurgical procedures ( p < 0.001), longer stays ( p = 0.017), and had greater morbidity at six months ( p = 0.017). A third of children had significant morbidity at six months, which included cognitive and behavioural problems (25%), residual hemiparesis (19%) and expressive dysphasia (7%). There were no mortalities. Conclusion Sinusitis complicated by intracranial abscess remains a contemporary problem. We demonstrate good outcomes with an early combined rhinological and neurosurgical approach. S. milleri is identified as the causative organism in the majority of cases, and empirical antimicrobial treatments should reflect this.