Endoscopic endonasal drainage of a foreign body-associated brain abscess

Although brain abscesses (BA) are uncommon, they represent a significant clinical challenge due to their potential for high morbidity and mortality. When combined with the presence of foreign bodies (FB), such as those resulting from penetrating craniofacial trauma, the management of BA becomes even more complex. Although craniotomy is the most frequent route described for resolution, endoscopic approaches for BA drainage or FB removal have not been widely documented.

A 29-year-old female with the antecedent of an assault two months before her referral to our hospital underwent cranial computed tomography (CT) and magnetic resonance imaging (MRI) revealing a penetrating FB through the left maxillary sinus to the anterior skull base associated with a left frontal abscess. The patient underwent a combined endonasal endoscopic and sublabial transmaxillary approach for FB extraction and navigation-guided abscess drainage using needle aspiration. A multilayer technique was employed for anterior skull base repair. The patient received an antibiotic scheme for six weeks and recovered without any neurological deficit. The control MRI showed complete resolution of BA.

Coexisting BA and penetrating FB represent a challenge for neurosurgical management. When indicated, endoscopic endonasal surgery is a useful tool for FB extraction and allows the resolution of associated complications, such as drainage of a BA.