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Intracranial complications of sinusitis in childhood
D N Lerner1, S S Choi, G H Zalzal
1Department of Otolaryngology-Head and Neck Surgery, Georgetown University, Washington, DC, USA.
Insights
Intracranial abscesses from sinusitis are rare in children but require prompt surgical sinus drainage and antimicrobial therapy. Effective management includes surgical exploration and sinus obliteration procedures for severe cases.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Otolaryngology
Background:
- Complications of sinusitis, including intracranial abscesses, are uncommon in children.
- These complications are often less clinically apparent in pediatric patients compared to adults.
Purpose of the Study:
- To review the incidence and management of intracranial abscesses secondary to sinusitis in pediatric patients.
- To evaluate the effectiveness of surgical interventions for sinusitis with intracranial extension.
Main Methods:
- Retrospective review of 443 children admitted for sinusitis between 1983 and 1991.
- Analysis of 14 pediatric patients who presented with intracranial extension and abscess formation.
- Evaluation of surgical management strategies, including sinus drainage and intracranial exploration.
Main Results:
- The risk of developing an intracranial abscess secondary to sinusitis was found to be 3% in this cohort.
- Surgical drainage of sinuses and intracranial exploration were key components of management.
- Cranialization and exenteration of the frontal sinus were effective single-stage procedures, preventing the need for secondary operations.
Conclusions:
- Combined antimicrobial therapy and surgical drainage form the recommended management protocol for pediatric sinusitis with intracranial extension.
- Specific surgical procedures like cranialization and exenteration can effectively resolve the infection and eliminate the sinus as a source of ongoing or potential future infection.
Abstract:
Complications of sinusitis in children, such as intracranial abscess formation, are uncommon and are often clinically unremarkable in comparison to similar disease processes in adults. Between 1983 and 1991, 443 children were admitted to Children's National Medical Center in Washington, DC, for treatment of sinusitis. Fourteen of these children presented with intracranial extension of the infection and abscess formation. A retrospective review of these patients revealed that the risk of developing an intracranial abscess secondary to sinusitis was 3%. The management of these patients included surgical drainage of the infected sinuses and intracranial surgical exploration. Cranialization and exenteration of the frontal sinus proved to be effective single-stage procedures. While not indicated in all patients, these procedures eliminated the sinus as a source of continued or potential infection and obviated the need for a second obliterative procedure. Combined antimicrobial therapy and surgical drainage should be the management protocol.