Multidisciplinary Simultaneous Drainage of Sinonasal and Intracranial Infections for Pediatric Rhinogenic Subdural...

Intracranial complications of acute rhinosinusitis have become rare in the antibiotic era, but delayed diagnosis and treatment can lead to severe or even fatal outcomes. Therefore, clinicians should always be aware of the potential for intracranial involvement when treating patients with paranasal sinus infections. We experience a case of an 11-year-old boy who developed a subdural abscess secondary to acute rhinosinusitis. The patient initially presented with frontal headache and vomiting on day 0, and computed tomography (CT) revealed left frontal, ethmoidal, and maxillary sinusitis. Despite intravenous antibiotic therapy with ceftriaxone, right lower limb paresis developed on day 5, and magnetic resonance imaging (MRI) demonstrated a left subdural abscess. Endoscopic sinus surgery (ESS) was performed at another hospital, but the abscess enlarged, leading to transfer to our institution. On admission, he exhibited impaired consciousness, right leg paresis, and diplopia. Emergency simultaneous ESS and burr-hole drainage were performed in collaboration between otorhinolaryngology and neurosurgery teams. Pus was drained from both the frontal sinus and subdural space, and a subdural drain was placed. Cultures of the pus were negative, and broad-spectrum antibiotics were continued. The patient's neurological symptoms gradually improved, and follow-up MRI on day 54 showed complete resolution of the abscess. He was discharged on day 55 without neurological sequelae. This case emphasizes the importance of accurate diagnosis and the rapid, simultaneous performance of paranasal sinus drainage and intracranial abscess drainage through multidisciplinary collaboration. We report such a pediatric case of acute rhinosinusitis complicated by a subdural abscess, together with a brief review of the relevant literature.