Gradenigo’s syndrome with abscess of the petrous apex in pediatric patients: what is the best treatment?

Savasta, Salvatore; Canzi, Pietro; Aprile, Federico; Michev, Alexandre; Foiadelli, Thomas; Manfrin, Marco; Benazzo, Marco

doi:10.1007/s00381-019-04352-4

Cited by 7 publications

(5 citation statements)

References 36 publications

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“…If major surgical intervention is warranted, important factors in determining the surgical approach to the petrous apex include the extent and location of disease, the anatomy of adjacent structures, whether the patient has serviceable hearing, and what the surgical team deems to be the shortest and least morbid route [ 2 , 20 ]. If a patient has impaired hearing ipsilateral to the lesion, a translabyrinthine or transcochlear approach can be considered.…”

Section: Discussionmentioning

confidence: 99%

“…In cases in which hearing is preserved, approaches that tend to spare hearing include endoscopic endonasal, open anterior petrosectomy, middle cranial fossa, or transcanal infracochlear [ 21 ]. Complications range from cerebrospinal fluid leak, postoperative meningitis, damage to vascular structures, which can lead to bleeding and stroke, and hearing loss, vertigo, or facial nerve damage [ 20 ]. Given the results by Gadre and Chole [ 2 ] and the potential for morbidity, following a multidisciplinary review of the case described, we chose to avoid surgical debridement of the petrous apex.…”

Section: Discussionmentioning

confidence: 99%

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Fusobacterium necrophorum an Underrecognized Cause of Petrous Apicitis Presenting with Gradenigo Syndrome: A Case Report

Ibrahim,

Fox-Lewis,

Correia

2023

Am J Case Rep

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Patient: Male, 21-year-old Final Diagnosis: Gradenigo syndrome • petrous apicitis • thrombosis of the cavernous sinus Symptoms: Cranial nerve palsy • facial numbness • headache • hearing loss • otalgia • otorrhea Clinical Procedure: Mastoidectomy Specialty: Infectious Diseases • Neurosurgery • Otolaryngology • Surgery Objective: Rare disease Background: With the advent of antibiotics, petrous apicitis (PA), inflammation of the petrous temporal bone, has become a rare complication of otitis media. Even more uncommon is Gradenigo syndrome (GS), a result of PA, characterized by a triad of otitis media or purulent otorrhea, pain within the regions innervated by the first and second division of the trigeminal nerve, and ipsilateral abducens nerve palsy. Recent literature has demonstrated increasing reports of Fusobacterium necrophorum isolated in cases of GS. Case Report: A 21-year-old man presented with otalgia, reduced hearing, and severe headache. Examination revealed right-sided purulent otorrhea, anesthesia within the trigeminal nerve distribution, and an ipsilateral abducens nerve palsy. F. necrophorum was isolated from an ear swab and a blood culture. Computed tomography and magnetic resonance imaging (MRI) demonstrated otomastoiditis, PA, cavernous sinus thrombosis, and severe stenosis of the petrous internal carotid artery. He was treated with intravenous benzylpenicillin, underwent a mastoidectomy and insertion of a ventilation tube, and was started on a 3-month course of dabigatran. Interval MRI showed improved internal carotid artery caliber, persistent petrous apex inflammation, and normal appearance of both cavernous sinuses. Follow-up clinical review noted persistent abducens and trigeminal nerve dysfunction. Conclusions: We identified 190 cases of PA; of these, 80 presented with the classic Gradenigo triad. Fusobacterium sp. were cultured in 10% of GS cases, making them the most frequent isolates. Due to the fastidious nature of F. necrophorum, it may be underrepresented in the historical literature, and we recommend that empiric antibiotics cover anaerobic organisms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Fusobacterium necrophorum an Underrecognized Cause of Petrous Apicitis Presenting with Gradenigo Syndrome: A Case Report

Ibrahim,

Fox-Lewis,

Correia

2023

Am J Case Rep

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“…There is no evidence confirming the efficacy of steroid, even though it has beneficial effects against inflammation and nerve damage. In several cases of GS, combination treatment with antibiotics and steroids has been effective [ 34 , 46 , 54 ].…”

Section: Discussionmentioning

confidence: 99%

Steroid-Responsive Gradenigo’s Syndrome Mimicking Subdural Hematoma

Liu¹,

Yeh²,

Lin³

et al. 2021

Cureus

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Gradenigo's syndrome (GS) is featured by a clinical triad of otorrhea, retro-orbital pain, and a sixth nerve palsy. Clinical examination is crucial prior to considering neuroimaging. The majority of cases are secondary to infection thus requiring long-term broad-spectrum antibiotics; severe cases also require surgical intervention for risk of intracranial abscess or even death. The patient was a 35-year-old female who presented with right temporal headache and right retro-orbital pain. The initial diagnosis from the local clinic was of subdural hemorrhage. Cranial nerve (CN) VI paresis was noted upon examination and inflammatory process was documented based on brain MR. The patient was diagnosed with Gradenigo's syndrome and administered antibiotics and steroids. Symptoms recurred after cessation of steroids and once antibiotics-related fever developed. The symptoms resolved after stopping the antibiotics and reintroducing steroids. The MRI performed after three months recorded no brain inflammation. We report a Gradenigo's syndrome caused by chronic inflammation with good response to steroids. To our best knowledge, there were merely approximately 80 patients who were reported with Gradnigo or Gradenigo’s syndrome before. Infection comprised 76% of cases, thus broad-spectrum and long-term antibiotics use have been emphasized instead of steroid use. However, steroids also play an important role in reducing nerve injury by edematous change.

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“…Petrous apicitis is a rare, but life‐threatening, entity associated with acute and chronic inflammatory process in the temporal bone. The pathophysiology relying on two different possibilities based on the pneumatization grade of the temporal bone is as follows: by contiguous evolution secondary to and middle ear infection in pneumatized temporal bones or by hematogenous spread in less pneumatized temporal bones 16 …”

Section: Discussionmentioning

confidence: 99%

“…Petrous apex abscess surgical treatment is a controversial topic. As Savasta et al 16 presented, from all pediatric patients with petrous abscess, only about 25% was submitted to direct drainage, being more common than other surgical interventions such as simple mastoidectomy or ventilation tube insertion. Surgical modalities are chosen based on preoperative hearing status, temporal bone anatomy, and surgeon’s experience 13 .…”

Section: Discussionmentioning

confidence: 99%

Conservative management of petrous apex abscess and Gradenigo's syndrome in a diabetic patient: Case report and literature review

Guimarães

Freitas

Silva

et al. 2020

Clinical Case Reports

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Gradenigo’s syndrome with abscess of the petrous apex in pediatric patients: what is the best treatment?

Cited by 7 publications

References 36 publications

Fusobacterium necrophorum an Underrecognized Cause of Petrous Apicitis Presenting with Gradenigo Syndrome: A Case Report

Fusobacterium necrophorum an Underrecognized Cause of Petrous Apicitis Presenting with Gradenigo Syndrome: A Case Report

Steroid-Responsive Gradenigo’s Syndrome Mimicking Subdural Hematoma

Conservative management of petrous apex abscess and Gradenigo's syndrome in a diabetic patient: Case report and literature review

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