Intracranial and Orbital Complications of Sinusitis: A Case Series and Review of Literature

Abstract

Complications of paranasal sinus infection most often involve the orbit and periorbita. Because of widespread use of antibiotics, intracranial extension of paranasal sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the potential of these complications, as late recognition of this condition and delay in treatment can increase morbidity and mortality rates. An interesting case series of sinusitis with orbital and intracranial complication is presented, which was radiologically evaluated, and was managed by endoscopic sinus surgery with drainage of subdural empyema by appropriate neurosurgical technique. The radiological tools played a very important role in both assessment and timing of surgical intervention. Unparallel role of radiological investigations cannot be overemphasized. The key to successful treatment is aggressive management and the timing for surgical intervention should not be deferred. The patients made full recovery at the time of discharge.

Odontogenic Pansinusitis Complicated by Orbital Cellulitis, Epidural Empyema and Intracerebral Abscess of Fronto-basal Region: Case Report

“…Despite the advent of newer antibiotics, diagnostic procedures and recent advances in management, it still precipitates with life-threatening intracranial complications [4,9]. The suppurative complications of sinusitis can be divided into intracranial and orbital.…”

“…Small abscesses and lesions in the stage of cerebritis respond well to medical therapy alone [24]. However, emergency surgical drainage of the epidural abscess or subdural empyema and any underlying sinusitis should be done [9]. Weekly or biweekly CT scans to monitor the size of the abscess are, however, mandatory following aspiration, and repeated aspirations may be required [25] Craniotomy is also recommended for multiloculated abscesses and larger lesions with significant mass effect that are superficial and located in noneloquent regions of the brain [21,26].…”

“…Third generation cephalosporins and metronidazole offers broad coverage and good brain-blood barrier and abscess penetration [9]. If adjacent osteomyelitis is present, prolonged intravenous therapy for a minimum duration of 6 to 8 weeks should be considered [13].…”

Subdural empyema as a rare complication of sinonasal infection: a case report and review of literature

“…20 Sinus surgery and abscess drainage are suggested for subdural empyemas occurring as a complication of sinusitis. 17,[19][20][21][22][23][24][25] We performed abscess drainage with craniotomy and sinus surgery in emergency conditions as the first step. Temporoparietal craniotomy was performed because of frontal lobe tissue sensitivity.…”