Simultaneous treatment of intracranial complications of paranasal sinusitis

Abstract

PurposeThe objective of this study was to analyse 51 patients with intracranial complications of sinusitis treated in the Department of Otolaryngology and Laryngeal Oncology at Poznań University of Medical Sciences from 1964 to 2016.Materials and methodsMales made up a significant portion of study participants at 70.5%. Treatment included simultaneous removal of inflammatory focal points in the paranasal sinuses and drainage of cerebral and epidural abscesses and subdural empyemas under the control of neuronavigation preceded by the implementation of broad-spectrum antibiotics continuously for 4 weeks. Seventy-three intracranial complications were found among 51 patients. Of the 51 patients, 25 had frontal lobe abscesses (including multiple abscesses). Other complications included the following: 16 epidural abscesses, 9 subdural empyemas, 15 meningitis cases, 3 intracerebral abscesses, 3 sinus thrombosis cases and 2 patients with cerebritis. Co-occurrence of these complications worsened the state of the patient and increased the duration of treatment. Patients with frontal lobe abscesses had a better prognosis and less pronounced neurological symptoms in recent years versus earlier treatment approaches.ConclusionsSimultaneous treatment of intracranial complications of sinusitis is an effective treatment method that has minimal burden for the patient. From 1964 to 1978, three deaths (17%) were reported among patients with these complications. Since 1978, no deaths were reported in the clinic.

Outcomes of endoscopic sinus surgery for sinusitis-induced intracranial abscess in patients undergoing neurosurgery

“…Several studies have shown that sinusitis-induced intracranial abscesses occur more commonly among adolescents and young adults in their 20s and 30s. 3,12,17,18 Our results are inconsistent with those of previous studies; we found that abscesses occur at any age, although the reason remains unclear.…”

Editorial. Endoscopic sinus surgery in sinusitis-induced intracranial abscess: concepts and controversies

“…The authors concluded that ESS does not add substantially to a reduction in mortality, readmission rates, reoperation rates, or length of hospital stay in patients with SIIA requiring neurosurgical intervention. 4 These conclusions are in contrast to some previously published reports 2,5 and are supported by others. 1,3 Koizumi et al 4 investigated the association between outcomes in patients undergoing neurosurgical interventions for SIIA and an ESS performed within the same hospitalization.…”

“…SIIA carries a mortality risk of 0%-7% and a morbidity risk of 10%-25%. [1][2][3]5 The most common patterns of SIIA in decreasing frequency are subdural empyema, intracerebral abscess, extradural abscess, meningitis, and, more rarely, sinus thrombosis. Intracranial spread of infective foci from the paranasal sinuses (PNSs) can result from either direct contiguous spread via bony defects/ ostomyelitic bone or indirect hematogenous spread via thrombophlebitis of valveless diploic veins draining PNSs, leading to spread of infection by thrombus propagation or release of septic emboli.…”

“…Intracranial spread of infective foci from the paranasal sinuses (PNSs) can result from either direct contiguous spread via bony defects/ ostomyelitic bone or indirect hematogenous spread via thrombophlebitis of valveless diploic veins draining PNSs, leading to spread of infection by thrombus propagation or release of septic emboli. [1][2][3]5 The latter is a much more common route seen in clinical practice, especially in the setting of acute rhinosinusitis (ARS). Adolescent males are most commonly affected by SIIA probably because of the formation of the PNSs in adolescence and a highly vascularized diploic venous system, more susceptible to indirect means of intracranial spread of infection.…”

“…Adolescent males are most commonly affected by SIIA probably because of the formation of the PNSs in adolescence and a highly vascularized diploic venous system, more susceptible to indirect means of intracranial spread of infection. [1][2][3]5 The radiological investigation of choice for patients with suspected SIIA is contrast-enhanced CT, primarily because it is easier to obtain in an emergency setting. However, gadolinium-enhanced MRI is complementary to CT in ascertaining potential complications of sinusitis.…”