Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature

Abstract

The objective of this study was to investigate the outcome of neurosurgical treated children with suppurative intracranial complications (SIC) of sinusitis over the past 28 years in our hospital. We reviewed the cases notes of a series of 11 consecutive paediatric patients, who were subjected to surgery for sinusitis-induced SIC, retrospectively. Eleven children (10 males and only one female) were underwent neurosurgical procedure in our hospital between 1978 and 2006. Their age at the time of diagnosis ranging from 13 to 17 years (mean 15.27 years, SD 1.737). The commonest presenting symptoms were headaches (81.8%) followed by vomiting (45.5%) and swelling of the forehead (45.5%). The most often involved sinus was the frontal sinus (63.6%) and sinus surgery was performed in eight (72.72%) of 11 cases. The neurosurgical procedures carried out included burr hole drainage or aspiration of abscess in five cases, craniotomy and evacuation of empyema in seven cases and craniectomy in two cases. Four (36.4%) of 11 patients had more than one neurosurgical operation due to re-accumulation of pus and worsening of their clinical status. Most common pathogen was Streptococcus species (81.9%), and anaerobes were isolated in three (27.3%) cases. Postoperative antibiotic treatment lasted from 26 to 70 days (mean 45.45 days, SD 15.280). Epilepsy was diagnosed in two patients, postoperatively. During the follow-up period, persistent focal neurological deficits were present in five (45.5%) of 11 patients. Interestingly, five (45.45%) cases occurred over the last 2 years (2005-2006) and the other six over the previous 16 years (1978-2006). Prompt and aggressive medical and neurosurgical intervention is required, aiming to minimize the morbidity and mortality and also to maximize the favourable outcome of those children.

Microbiology of acute complicated bacterial sinusitis at the University of the Witwatersrand

“…2,4,11 Recent publications mention S. milleri as being the most common pathogen in patients with complicated sinusitis. 4,5,8 Whereas this is in agreement with the overall findings of this study, it was true of CHB (28.1%) but not of JH (2.3%). The notable absence of S. milleri as seen at JH is also reported by other authors.…”

“…This is in keeping with the universal acceptance of this organism as a major pathogen. [3][4][5][6][7][8]11,14,15 H. influenzae (8.6%) and coagulase-negative staphylococci (8.6%) ranked joint third. H. influenzae occurred more frequently in children than in adults (Table II).…”

“…1,2,[4][5][6]12 Equivalent studies attach no importance to H. influenzae as a pathogen. 3,8,11,13 Coagulase-negative staphylococci have long been regarded as non-pathogenic, but in a recent study their role as important pathogens is recognised. 6 In this study coagulase-negative staphylococci occurred more frequently in adults than in children (Table II).…”

Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years

“…29 Typically, patients with intracranial complications of acute bacterial sinusitis are previously healthy adolescent males with frontal sinusitis. 33,34 There have been no head-to-head comparisons of the diagnostic accuracy of contrast-enhanced CT scanning to MRI with contrast in the evaluation of orbital and intracranial complications of sinusitis in children. In general, the contrast-enhanced CT scan has been the preferred imaging study when complications of sinusitis are suspected.…”

“…Intracranial complications are most frequently encountered in previously healthy adolescent males with frontal sinusitis. 33,34 In patients with altered mental status, severe headache, or Pott' s puffy tumor (osteomyelitis of the frontal bone), neurosurgical consultation should be obtained. A contrast-enhanced CT scan (preferably coronal thin cut) of the head, orbits, and sinuses is essential to confirm intracranial or intraorbital suppurative complications; in such cases, intravenous antibiotics should be started immediately.…”