Arq Bras Neurocir 24(3): 98-111, setembro de 2005 IntroduçãoDentre as complicações infecciosas intracranianas de origem otorrinolaringológicas (ORL), existem aquelas que ocupam espaço: abscesso epidural (AED), empiema subdural (ESD) e abscesso intracraniano (AIC). As complicações infecciosas intracranianas em pacientes portadores de infecções otorrinolaringoló-gicas podem ser de origem otológica ou nasossinusal. Permanecem com elevados índices de morbidade e mortalidade, sendo ainda hoje prevalentes em populações carentes, mas com incidência considerável mesmo em países desenvolvidos e com bom nível de assistência à saúde 60,76 . Complicações intracranianas decorrentes de infecções otorrinolaringológicas PALAVRAS-CHAVEInfecções otorrinolaringológicas, complicações. Abscesso cerebral. Empiema subdural. A rinossinusite pode ser descrita como uma inflamação da mucosa nasossinusal em resposta à ação de eventos infecciosos, traumáticos, químicos ou mesmo ação de alérgenos desencadeando um estado inflamatório da mucosa. Tal evento, inicialmente, tem características agudas que podem ser resolvidas espontaneamente ou por meio da ação de medicamentos que irão interagir para normalizar a mucosa do nariz e dos seios paranasais. Entretanto, em alguns casos isso não ocorre e a persistência de tais alterações leva a estado de cronificação 23 . As otites médias agudas traduzem processos inflamatórios agudos do ouvido médio. São desencadeadas pela infecção das cavidades nasais e paranasais e rino- ABSTRACT Intracranial complications of otorhinological infections In spite of the reduction in the incidence of intracranial complications elapsing from otorhinolaryngological infections after modern antibiotic therapy, these stay as extremely serious complications. A review on intracranial complications from nasosinusal and otological infections is made. It is concluded that intracranial infections secondary to otorhinolaryngological focus are still a serious complication with high mortality and morbidity rates. KEY-WORDS

Introduction  Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective  To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods  This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results  The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion  The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution.

Despite the reduction in the incidence of intracranial complications of otorhinological infections after the coming of the antimicrobial therapy, these stay as extremely serious affections.The purpose of this re p o rt was to analyze re t ro s p e ctively the intracranial complications of rh i n o s i n u s i t i s and otitis media in patients interned in the neurosurgical unit at Hospital Governador João Alves Filho in Aracaju -SE, between january of 1995 and september of 2004.T h i rty patients were studied, being 57% of the masculine gender and 43% feminine. With re g a rd to the age, there was a prevalence in the first and second decades of life (83,3%). The source of infections was rhino-sinusitis in 70% of the patients and otitis media in 30%. The most commom form of complicationwas a intracranial abscess (53%), followed by subdural empyema (40%) and extradural abscess (7%). The main clinical pre s e n t a t i o n s were headache (86,7%), altered consciousness (80%), fever (76,7%) and vomit (76,7%). About the location of the lesions, 66,7% of the intracranial abscesses of rhinosinoseginc origin were located in the frontal lobe, while 57,1% of those of otologic origin were located in the cerebellum. The subdural empyemas were located in convexity in 58,3% of the cases. One extradural abscess was located in the frontal lobe and another in parietaland occipital lobes.Surgical treatment was undertaken in 23 patients, while 7 patients were treated without surg e ry. Seventhy p e rcent of the patients survived and 52,4% of these p resented sequelaes, being the hemiparesia the most fre-THESES quent (63,6%). It is concluded that the otorhinological intracranial complications are quite serious illness, with high mortality rate and frequent sequelaes.

Introduction Premalignant lesions are considered both a hyperplastic and dysplastic stage of epithelial lesions in the glottic larynx that may or may not progress into an invasive carcinoma. The evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies. Objective The goal of this study was to determine the accuracy of the preoperative exam for diagnosis of premalignant laryngeal lesions and their connection with benign diseases of the vocal folds, as well as to assess their epidemiologic characteristics. Methods This is a retrospective and longitudinal cohort study performed through the review of surgical records of patients who underwent laryngeal microsurgery performed by a single surgeon from 1990 to 2009. Results Preoperative assessment of outpatients was 64.4% accurate. Vocal fold cysts were the most frequently associated benign lesions. The patients who apparently had premalignant lesions represented 10.57% of those who underwent laryngeal microsurgery. Premalignant lesions prevailed in men (69.49%) age from 41 to 50 years (32.20%). Conclusion Although the evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies, about one-third of premalignant lesions are diagnosed just during the laryngeal microsurgery. Cysts were the most prevalent concomitant benign lesion of the vocal folds. Males were more prevalent than females and the predominant age bracket was between 41 and 50 years.

Introduction Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing. Objectives To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleep-disordered breathing subscale in the Sleep Disturbance Scale for Children. Method Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale. Results Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy. Conclusion Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.