Single stage, transmastoid approach for otogenic intracranial abscess

To evaluate the treatment of intracranial abscess of otogenic origin, and to study the outcome measures of single stage treatment of the otogenic focus and drainage of intracranial abscess via a transmastoid approach.

Retrospective case review.

Dr Balabhai Nanavati Hospital and Medical Research Centre, Mumbai, India, an academic tertiary referral centre, and Shri H Bhagwati Municipal General Hospital, Mumbai, India, an academic secondary referral centre.

Seventy-three patients with intracranial abscess secondary to otogenic pathology, confirmed by computed tomographic scanning.

Single stage treatment of the ear pathology and drainage of intracranial abscess via a transmastoid approach, performed by the senior author (KPM).

Of the 73 patients, 12 were lost to follow up and were excluded from the study. Outcomes for the remaining 61 patients were known, and these patients were followed up for at least two years. Adults were more commonly affected by otogenic intracranial abscess than children, with a male preponderance. Otogenic intracranial abscess was associated with both cholesteatomatous (41 per cent) and non-cholesteatomatous ears (59 per cent). All cases were treated with transmastoid drainage of the intracranial abscess and canal wall up or down tympanomastoidectomy, depending on the ear pathology. Two cases developed post-operative cerebrospinal fluid leakage (3 per cent), and another two cases developed meningitis (3 per cent). Five patients had recurrent abscess; two of these patients (3 per cent) died but were included in the study. Three patients had residual abscess, improved with additional management.

In this series, the low morbidity and mortality rate, combined with a shorter hospital stay, suggest that single stage, transmastoid drainage of intracranial abscess and concurrent treatment of the otogenic pathology is an effective treatment for otogenic intracranial abscess.