Endonasal trans-ethmoidal drainage of a cerebral abscess

Cerebral abscesses are rare but often lethal complications of invasive Aspergillus sinusitis. Treatment is difficult and usually depends on a combination of neurosurgical drainage and intravenous antifungal therapy. We report a case of intracerebral frontal abscess in continuity with the anterior skull base in a 53-year-old immunocompromised female with invasive rhino-orbital aspergillosis. An aperture was created by drilling the anterior skull base during endonasal sinus surgery, and the abscess was drained through its lower pole. The aperture was left open after surgery to ensure complete abscess drainage. Follow-up at 8 months revealed no cerebrospinal fluid leak or meningitis, and no abscess recurrence. This case validates the feasibility of endonasal trans-ethmoidal drainage of intracranial abscesses.