Management and outcomes in children with sinogenic intracranial abscesses
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 includ...
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Published in | International journal of pediatric otorhinolaryngology Vol. 79; no. 6; pp. 868 - 873 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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Elsevier B.V
01.06.2015
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Abstract | 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. |
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AbstractList | To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management.
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.
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.
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. 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. OBJECTIVETo report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. METHODSAll 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. RESULTSWe 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. CONCLUSIONSinusitis 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. To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. 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. 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. 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. |
Author | Masterson, Liam Fish, Brian M Patel, Anant P Deutsch, Christopher J Scoffings, Daniel J |
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Keywords | Brain abscess Complicated sinusitis Intracranial abscess Paediatric sinogenic abscess |
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Snippet | Abstract Objective To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management.... To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. All children with... OBJECTIVETo report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management. METHODSAll... |
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SubjectTerms | 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 |
Title | Management and outcomes in children with sinogenic intracranial abscesses |
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