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Pediatric Sinogenic Subdural Empyema: Case Report and Operative Technique
Giuseppe Raguso1, Nicola Cornale1, Rita Rebelo1
1Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Piazzale L.A. Scuro, 10, 37134 Verona, VR Italy.
Insights
Intracranial complications of sinusitis, like subdural empyema, are rare but serious in children. Prompt diagnosis and combined medical-surgical treatment are crucial for recovery and preventing permanent brain damage.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Otolaryngology
Background:
- Intracranial complications of sinusitis are rare but life-threatening in children.
- Nonspecific symptoms like headache and fever can mask serious neurological conditions.
- Early diagnosis and prompt treatment are essential to prevent severe morbidity and mortality.
Purpose of the Study:
- To report a case of sinogenic subdural empyema in an immunocompetent child.
- To describe the diagnostic process and management of this rare complication.
- To emphasize the importance of multidisciplinary care in pediatric sinusitis complications.
Main Methods:
- Case report of a young boy with sinogenic subdural empyema.
- Initial assessment included laboratory tests, neurological and ENT evaluations, and CT scan.
- Diagnosis confirmed by MRI, followed by surgical drainage (craniotomy and endoscopic) and antibiotic therapy.
Main Results:
- The patient presented with headache, initially treated with antibiotics.
- Sudden neurological deterioration prompted MRI, revealing subdural empyema and midline shift.
- Combined surgical and medical treatment led to full neurological recovery without deficits.
Conclusions:
- Subdural empyema is a severe complication of pediatric sinusitis requiring urgent intervention.
- Multidisciplinary approach involving neurosurgery and ENT is key for successful outcomes.
- Early recognition and prompt, combined therapy significantly reduce morbidity and mortality.
Abstract:
Intracranial complications of sinusitis in the pediatric age are rare but potentially life threatening. They usually occur with nonspecific symptoms such as headache, fever, nausea and vomiting rather than a classic neurological presentation, but they may evolve in few hours, leading to significant morbidity with permanent brain damage and sometimes to death. For this reason, early diagnosis and prompt treatment are essential. Our case demonstrates a sinogenic subdural empyema in an immunocompetent young boy who reached our Emergency Department due to a continuous right-sided headache, unresponsive to pain relievers. The clinical history and the diagnostic process are described: at first, laboratory exams, neurologic and otolaryngological assessment were performed, together with a cranial CT scan showing an inflammatory involvement of the right frontal, ethmoidal and maxillary sinuses. Intravenous antibiotic therapy was initiated. After a few hours the patient showed a sudden worsening of his clinical conditions: he was drowsy with left lower extremity hyposthenia and ipsilateral deep tendon reflexes absence. Considering the patient's aggravated clinical presentation an emergent MRI with contrast enhancement was conducted, showing left midline shift, a widening of the liquor space on the right frontal and parietal convexity and noticeable meningeal enhancement after contrast injection. After a Neurosurgical and ENT evaluation the patient was taken to the operating room for a combined craniotomy and trans-nasal endoscopic drainage of the empyema. We present the surgical procedure with a pictorial step-by-step description. After the surgical procedure the patient's condition gradually improved. He regained full neurological function, was accompanied by a rehabilitation team on recovering full force on the left extremities. At discharge the patient had no apparent neurological deficits. Subdural empyema is a rare but severe complication of pediatric sinusitis. Early diagnosis with combined medical and surgical therapies play a key role to reduce morbidity and mortality.
