Intracranial abscess after anterior skull base defect: does pneumocephalus play a role?

Abstract

Background: Intracranial complications of skull base defects are uncommon; however, they can be devastating when they do occur. Often these complications arise suddenly and without warning. Identifying patients at risk for intracranial abscesses may help with early diagnosis and allow for early interventions. Objective: We report on 2 patients with traumatic pneumocephalus who developed intracranial abscesses. Our objective was to evaluate these cases and investigate the relationship between the presence of pneumocephalus and the formation of intracranial infection. Methods: Data was reviewed on the cases of 2 patients who developed intracranial abscesses after pneumocephalus in the context of skull base defects. Results: Two patients presented to our institution separately with the presence of intracranial abscesses. Both patients had violation of their anterior skull base-one from endoscopic sinus surgery, one from blunt trauma. Both patients had massive pneumocephalus prior to their abscess formation. Conclusions: Intracranial abscess formation, traumatic skull base defects, and massive pneumocephalus are uncommon entities, which may be associated. It may be prudent to have heightened suspicion for the presence of intracranial abscess formation in patients with massive pneumocephalus secondary to anterior skull base trauma.

Development of posttraumatic frontal brain abscess in association with an orbital roof fracture and odontogenic abscess: A case report

“…[ 13 ] In blunt traumatic injury associated with an anterior skull base defect, these injuries are at higher risk of causing an infection when a CSF leak develops. [ 2 ] This was not present in the patient above. Periorbital wounds, especially those associated with orbital fractures, may also present with brain abscess if foreign bodies which may have gone undetected caused contamination of orbital contents.…”

The Role of the Endonasal Endoscope in the Operative Management of Brain Abscess: A Case Report

“…The endonasal endoscope has been well used in head and neck surgery to date for the repair of anterior skull-based defects. 7 It shares the minimally invasive characteristics of traditional stereotactic aspiration with the associated advantages relative to craniotomy described previously. Similarly, it does share the drawback of stereotaxy in that neither procedure removes the abscess cavity membrane the way the open technique does.…”

Double flap technique for reconstruction of anterior skull base defects after craniofacial tumor resection: technical note

“…CSF leaks have been reported to occur in 2% to 13% of skull base surgeries . Associated meningitis has been observed in 1% to 5% of the cases and rarely an intracranial abscess, tension pneumocephalus, or osteomyelitis can occur.…”