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Sinogenic Intracranial Suppuration in Children: Systematic Review and Meta-analysis
Kristijonas Milinis1, Nathan Thompson1, Smadar Cohen Atsmoni1
1Alder Hey Children's Hospital, Liverpool, UK.
Insights
Outcomes for pediatric sinogenic intracranial suppuration remain unchanged over 45 years. Endoscopic sinus surgery (ESS) did not improve mortality or neurological disability in children with these infections.
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.
Objective:
To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children.
Data Sources:
A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov).
Review Methods:
Studies in children (age <18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death <90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes.
Results:
A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%; I2 = 0, P > .99), 21.3% (95% CI, 15.3%-27.3%; I2 = 75.2%, P < .001), and 37.3% (95% CI, 29.5%-45%; I2 = 71.2%, P < .001), respectively, with no significant differences found across the study period. The pooled estimate for ESS was 58.4% (95% CI, 44.2%-72.6%; I2 = 97.1%, P < .001) with a significantly increasing trend in its use in the more recent years. ESS was not associated with improved mortality, reduced need for revision surgery, or neurologic disability.
Conclusion:
The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.
