Sinogenic Intracranial Suppuration in Children: Systematic Review and Meta-analysis.

Area of Science:

• Pediatric Neurosurgery
• Otolaryngology
• Infectious Diseases

Background:

• Sinogenic intracranial suppuration presents significant morbidity in children.
• Temporal trends in management and outcomes require evaluation.

Purpose of the Study:

• To assess changes in the management and outcomes of pediatric sinogenic intracranial suppuration over time.
• To investigate the impact of endoscopic sinus surgery (ESS) on patient outcomes.

Main Methods:

• Systematic search of multiple databases (Medline, Embase, Cochrane, ClinicalTrials.gov).
• Inclusion of studies on children (<18 years) with sinogenic subdural empyema, extradural abscess, or intraparenchymal abscess.
• Random effects meta-analysis and meta-regression to analyze temporal trends and ESS effects on mortality, revision surgery, and neurological disability.

Main Results:

• Analysis of 32 studies (1975-2020) involving 533 patients.
• Pooled 90-day mortality was 2.3%, permanent neurologic disability 21.3%, and return to theater 37.3%, with no significant changes over time.
• Endoscopic sinus surgery (ESS) use increased significantly in recent years but was not associated with improved outcomes.

Conclusions:

• Outcomes for sinogenic intracranial complications in children have not improved over the past 45 years.
• Endoscopic sinus surgery (ESS) did not demonstrate a benefit in improving patient outcomes.
• Further high-quality research is needed to identify optimal treatment strategies for sinogenic intracranial suppuration in children.