Intracranial complications of frontal sinusitis

Abstract

Frontal sinus infections can spread to the intracranial space so fast that the clinical situation often becomes far advanced before a complication is recognized. Retrograde septic thrombophlebitis is the most common pathway of extension. A review of recent experiences with fulminating frontal sinusitis and its intracranial complications such as subdural empyema, brain abscess, epidural abscess, and meningitis is presented. Neurologic features of intracranial invasion are interpreted. Good results have been achieved by immediate and aggressive surgical and medical measures.

Intracranial Complications of Frontal Sinusitis in Children: Pott’s Puffy Tumor Revisited

“…Although direct extension of purulent material through an osteomyelitic frontal bone is an obvious mode of infectious spread to the epidural space, it does not explain the presence of subdural empyema without epidural abscess or dural violation. Both of these situations have been observed in the present series and have been described previously [5, 9]. The mechanism for this is best understood when one considers the anatomic relationship between the frontal sinus and the intracranial space.…”

“…Since the introduction of antibiotics, only 21 pediatric cases of Pott’s puffy tumor have been reported [3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17]. Of these, only 1 was secondary to trauma [10].…”

A Case of Rhinogenic Intracranial Complication: Epidural Abscess

“…Epidural abscesses develop slowly 12,13 , and can be improved only by otorhinolaryngologic surgery 2 . In this case, craniotomy was not required, but we prescribed antibiotics and performed ESS, which improved the acute rhinosinusitis and the epidural abscess.…”

Brain Infection After Cesarean Section: A Case of Subdural Empyema Post-Cesarean Section

“…The infection could be expanded from two sides. One of them is mastoiditis or acute and chronic otitis media by erosion of the tegmen tympani (5) and the other one is spreading by erosion of the posterior wall of the frontal sinus (6). The infection may be caused by spreading the septic thromboemboli from thrombophlebitis or infected venous sinus thrombosis (7)(8)(9)(10).…”

“…The prognosis of the patient directly depends on early diagnosis and rapid initiation of appropriate antibiotic regimens and surgical intervention (13,14). The rate of a positive culture from surgically drained material and pus varies from 54% to 81% (6,10,15). Most common organisms secondary to sinusitis are anaerobes and in postoperative and post-traumatic are S. aureus (16,17).…”