Endoscopic endonasal surgery for intracranial rhinogenic complications. Analysis of two clinical cases

Abstract

Rhinogenic intracranial complications, such as brain abscess and thrombosis of the veins and sinuses of the brain, are still a formidable, life-threatening pathology, often resulting in death, despite the widespread development of antibiotic therapy and adherence of patients to the treatment. Often the cause of the development of intracranial complications is the exacerbation of a chronic inflammatory process in the paranasal sinuses, while acute ENT pathology of the sinuses leads to the development of rhinogenic complications only in a small percentage of cases. Unfortunately, the high development of radiation and laboratory diagnostics does not always allow diagnosing these conditions in time and providing adequate surgical care. In childhood and adolescence, it is important to perform a timely complete and at the same time minimally invasive, non-disabling, surgical intervention. An analysis of foreign literature in recent years shows that neurosurgical operations in various volumes (from trepanopuncture of the brain to craniotomy) occur in the vast majority of cases of treatment of rhinogenic intracranial complications. The article presents two clinical cases of patients with intracranial complications successfully treated in the Department of Otorhinolaryngology of St. Petersburg State Pediatric Medical University without a highly traumatic neurosurgical operation. The combination of endonasal endoscopic surgery and massive adequate conservative therapy (antibiotic therapy in combination with the use of anticoagulants for sinus thrombosis) allows the patient to recover without resorting to neurosurgical intervention.

Cavernous sinus thrombosis as a cause of fatal outcomes in forensic medical practice

“…Тромбоз кавернозного синуса может быть вызван различными возбудителями, большинство из которых имеют бактериальную природу. Наряду с наиболее распространёнными, такими как золотистый стафилококк, стрептококки и пневмококки, встречаются анаэробные микроорганизмы (фузобактерии, актиномицеты и бактероиды), а также грибковая инфекция (аспергиллёз, зигомикоз) и клеточные паразиты (токсоплазмы, малярийные плазмодии, трихинеллы) [8,9]. Вирусная инфекция (простой герпес, корь, цитомегаловирус) до повсеместного развития коронавирусной инфекции также относилась к редким причинам развития тромбоза кавернозного синуса [10].…”