Intracranial Complications following Mastoidectomy

Abstract

Mastoidectomy is a common surgical procedure in otology. However, postoperative complications of various degrees of severity may occur. We present4 children who underwent mastoidectomy for middle ear and mastoid disease and developed postoperative intracranial complications. One child was operated on for brain abscess 1 week after the initial mastoidectomy. Another child appeared with seizures 5 days after the initial mastoidectomy and a subdural empyema was drained during revision surgery. Large bone defects with exposed middle cranial fossa dura were found at revision surgery in both cases and Proteus vulgaris and methicillin-resistant Staphylococcus aureus were isolated from the mastoid and abscess cavities in these children. A small epidural collection was diagnosed in the third patient 2 days after initial mastoid surgery and was managed with intravenous antibiotics only. The other child was found to have sigmoid sinus thrombosis the day after mastoidectomy that was performed for nonresponsive acute mastoiditis. This child received both intravenous antibiotics and anticoagulants. Timely revision surgery, combinations of third- or fourth-generation cephalosporins with vancomycin or metronidazole and the addition of anticoagulants in cases of sinus thrombosis can lead to full recovery.

Indications for surgery in acute mastoiditis and their complications in children

“…In some centres a cortical mastoidectomy is performed in all instances, including very young children, starting from 8 months of age [29]. Other management options include the evacuation of the subperiosteal abscess by incision and drainage [30,31] and the exploratory puncture, either alone [32] or associated with myringotomy [33]. Based on our experience, we agree with the clinical studies that recommend mastoidectomy only for complications or failures to improve with antibiotics and myringotomy [25,34,35].…”

Management of brain abscess in children

“…The factors predisposing to brain abscess are: contiguous infection, haematogenous dissemination and penetrating head injuries including neurosurgical procedures 1,11 . In our series, the most important predisposing factor was a contiguous spread of infection accounting for 11/28 cases.…”

Seizure activity following cochlear implantation: Is it the implant?

“…In addition, Migirov et al described a mastoidectomy procedure on a 16-yearold boy who suffered from a cholesteatoma. The patient presented 5 days later with seizures and a subdural empyema [14]. These cases demonstrate that post-surgical irritation of the temporal lobe, either from prolonged retraction or infection, can potentially lead to new-onset seizures.…”