Intracranial complications of acute frontal sinusitis

Abstract

Despite advances in the diagnosis and treatment of acute frontal sinusitis, there is still significant occurrence of intracranial complications. Urgent surgical evacuation of any intracranial collection is required; however, the surgical management of the associated sinusitis remains controversial. Ten patients presented to this department over a 12-month period with subdural empyema secondary to acute frontal sinusitis. Four patients had a coexisting Pott's puffy tumour and one patient had a periorbital abscess. Each patient was managed using a multidisciplinary approach. A frontal sinus trephine/drain +/- antral washout was performed at the same time as craniotomy with evacuation of the empyema. With this approach only two patients suffered long-term morbidity in our series, in the form of persistent neurological or cognitive deficit. No patient required a definitive sinus procedure. This study emphasizes the need for the early assessment and intervention of patients with an intracranial complication secondary to acute frontal sinusitis. Further assessment of the underlying sinus disease is indicated during outpatient follow up after the acute episode.

Osteomyelitis of the frontal bone

“…Urgent surgical evacuation of any intracranial collection is required. Surgical management of associated sinusitis remains controversial 8 . The source of the infection must be eradicated.…”

Puffy Frontal Edema: A Serious Life-Threatening Finding of Pott’s Puffy Tumor: Case Report

“…These thinwalled, valveless vessels facilitate the hematogenous spread of the sinus infection to the bone and the brain. 7,8 The usual route for infection spread is from the frontal sinus to the frontal bone. The infection may further erode through the bony cortex, leading to the subperiosteal collection of pus described by Pott, or erode inward causing meningitis, epidural or subdural empyema, frontal lobe abscess, or cavernous sinus thrombosis.…”

“…17,18 Despite antimicrobial therapy, the mortality rate is 5-17%. 8,16 Symptoms including headache and little or no fever are often indolent. Increasing symptoms suggest complications.…”

Obliteración del seno frontal mediante injerto de tibia y plasma rico en plaquetas para el tratamiento de la osteomielitis crónica

“…El desarrollo de una osteomielitis del seno frontal como complicación de una sinusitis frontal es poco frecuente, pero siempre hay que sospecharlo ante un paciente diagnosticado previamente de una sinusitis frontal o una pansinusitis y que refiera síntomas tales como cefalea frontal, fiebre (los dos síntomas más comunes de presentación) o supuración 5,12 . El diagnóstico se basará tanto en la clínica como en las pruebas de imagen; la fundamental será una TAC, con o sin contraste.…”

“…Aceptado: 18-10-05 retraso en el tratamiento pueden incrementar las tasas de morbilidad y mortalidad 7,13,14,24 . El manejo terapéutico, tanto de las sinusitis frontales crónicas como de las osteomielitis crónicas, requiere no sólo un tratamiento farmacológico (antibioterapia), sino además quirúrgico 12 . La técnica quirúrgica que se ha demostrado más eficaz en el tratamiento de la osteomielitis frontal crónica es la realización de un colgajo osteoplástico, limpieza y legrado, y la obliteración del seno frontal.…”