Intracranial Complications of Sinusitis: A Pediatric Series

Abstract

Intracranial complications of sinusitis (ICS) (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and contemporary topic. The progressive pneumatization and continued development of the sinuses after birth and the late appearance of the frontal and sphenoid sinuses imply that some infections would not appear until later childhood. We reviewed the records at a large pediatric hospital between 1986 and 1995 and found 10 children with 13 ICS (cerebral abscess, 5; extra-axial empyema, 5; and meningitis, 3). Of 43 children with cerebral abscess and 16 with extra-axial abscesses treated in this period, 12% of cerebral and 63% of extra axial abscesses were due to a sinogenic source. Multiple intracranial and extracranial complications of sinusitis in a single patient were common. The average age of children with ICS was 12.2 years old. We present these 10 cases and discuss their presentation, microbiology, and clinical course. Although the majority presented with a classic picture of headache, altered mental status, and fever, a few had symptoms that were more subtle. One child had recurrent meningitis, believed to be due to skull base dehiscence after endoscopic sinus surgery (ESS). He has required multiple otolaryngologic and neurosurgical procedures in an effort to prevent further episodes of meningitis. Ultimately, nine of 10 patients survived with an average hospital stay of 27.8 days (median of 17 days). The diagnosis of ICS requires a high index of suspicion, imaging of the brain and paranasal sinuses, and aggressive intervention.

Osteomyelitis of the frontal bone

“…The diagnosing of intracranial complications of sinusitis requires a high index of suspicion, imaging of brain and paranasal sinuses and aggressive intervention 6 .…”

Sinogenic Intracranial Empyema in Children

“…[3][4][5][6][7][8][9][10][11] However, the majority have been in specialty journals that may not be accessed routinely by primary care or emergency physicians. [3][4][5][6][7][8][9][10][11] Our experience with SIE patients suggests that nearly all present initially to their primary care provider or an emergency department. Therefore, it is important that generalist pediatric care providers are aware of the clinical, laboratory, and radiographic findings associated with SIE so that prompt diagnosis and treatment can be provided.…”

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

“…12 Giannoni et al reviewed infected sinus origins in 12% of cranial abscess (43 cases) and 63% of extracranial abscess (16 cases); the average age was 12.2 years. 11 In a study by Skelton et al, 7 of 10 patients had subdural empyema, 2 of 10 were extradural empyema and one patient had both complications with sinusitis. 13 The first approach in the treatment of all patients was followed up with antibiotics; no improvement was detected with antibiotic treatment.…”

“…10 Sinus infections do not appear until late childhood because of sinus development and pneumatization after birth. 11 Subdural empyema often occurs in healthy people in the second decade of life. 12 Giannoni et al reviewed infected sinus origins in 12% of cranial abscess (43 cases) and 63% of extracranial abscess (16 cases); the average age was 12.2 years.…”