A Systematic Review of Intracranial Complications in Adults with Pott Puffy Tumor over Four Decades

Abstract

The purpose of this study is to investigate the risk factors of intracranial complications in adult patients with Pott Puffy Tumor (PPT). A systematic review was conducted of clinical studies from January 1983 to December 2022 that reported on PPT adult patients. The full-text articles were reviewed for the patients’ ages, sex, cultured organisms, surgical procedures, clinical sequalae, and underlying diseases that may affect the onset of intracranial complications in PPT adult patients. A total of 106 studies were included. Medical data were reviewed for 125 patients (94 males, 31 females). The median age was 45 years. A total of 52% had comorbidities, mostly head trauma (24.5%), sinus/neurosurgical operations (22.4%), immunosuppression conditions (13.3%), diabetes mellitus (9.1%), cocaine use (7.1%), or dental infections (6.1%). A total of 28 cultures revealed Streptococcus (22.4%), 24 contained staphylococci (19.2%), and 22 cultures contained other pathogens (17.6%). An amount of 30.4% developed intracranial complications, with the most common being epidural abscesses or empyemas (55.3%), as well as subdural (15.7%) and extradural lesions (13.2%). Age, DM, and immunosuppression conditions are significantly associated with intracranial complications (p < 0.001, p = 0.018 and p = 0.022, respectively). Streptococcus infection is associated with intracranial complications (p = 0.001), although Staphylococcus and other microorganisms are not. Surgical intervention, mainly ESS, and broad-spectrum antibiotics remain the cornerstones of treatment.

Osteomyelitis of Frontal Sinus: A Rare Sequelae of Acute Bacterial Sinusitis Associated With Anatomical Variations in the Frontal Sinus Drainage Pathway

“…Up to 30% of cases of PPT are associated with intracranial complications, in the form of frontal sinusitis, osteomyelitis, and subperiosteal abscess. The existence of intracranial problems, neurological clinical indications, and worsening of common symptoms 48 hours after intravenous antibiotic therapy suggests that surgical drainage is required immediately [1]. There was no frank abscess formation either subperiosteal or intracranial; however, the patient had forehead scalp edema and pre-septal cellulitis.…”

“…Frontal osteomyelitis can develop as a result of frontal sinusitis or trauma, developing into frontal osteomyelitis with accompanying subperiosteal abscess. The classic triad of frontal sinusitis, osteomyelitis, and subperiosteal abscess formation is characteristic of Pott's puffy tumor (PPT) [1]. It is predominant in the younger population with a male predominance.…”

“…Headache, purulent rhinorrhea, fever, frontal sinus pain, and periorbital edema are the most prevalent symptoms. Vomiting, headache, fever, change in mental status, lethargy, seizure, and other clinical symptoms may indicate intracranial problems [1,2].…”

Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study

“…Potential risk factors were defined as previous diagnoses from KUHR or NPR for risk factors based on findings from previous literature, 20–23 including chronic sinusitis or previous sinus surgery, previous head trauma, skull surgery or congenital skull malformations, chronic reactive airway disease, malignancy or immunosuppression (see Table S1 , available as Supplementary data at JAC Online, for all risk factors included). Malignancy was defined as any previous cancer diagnosis of any organ as registered in KUHR or NPR.…”

Tumor edematoso de Pott (Pott‘s puffy tumor) em paciente pediatrico: um relato de caso

“…Sir Percival Pott descreveu como um tumor secundário a uma coleção devido ao acometimento ósseo de localização subgaleal, tempos depois foi demonstrado que pode ser secundário a osteomielite do osso frontal 2 . É mais comum em adolescentes em virtude do aumento da vascularização na circulação diploica do seio frontal nessa faixa etária, o que permite a propagação mais rápida da infecção que é a sinusite aguda frontal que pode evoluir com complicações intra ou extracranianas por meio da disseminação venosa (mais frequente) com tromboflebite das veias diploicas e êmbolos sépticos ou por extensão direta 3,4 .…”