Management Strategy of Intracranial Complications of Sinusitis: Our Experience and Review of the Literature

Abstract

Objective Sinusitis or rhinosinusitis is a very common disease worldwide, and in some cases, it leads to intracranial complications (ICS). These are more common in immunocompromised patients or with underlying comorbidities, but even healthy individuals, can be affected. Nowadays, ICS have become less common thanks to improved antibiotic therapies, radiological diagnostic methods, surgical techniques and skills. Nonetheless, they can still cause significant morbidity and mortality. For this reason, management of these complications requires a multidisciplinary approach to plan and customize treatment options. This paper presents our strategy in the management of a series of intracranial complications induced by acute sinusitis and compares our experience and outcomes with the literature. Study design Single institute experience, retrospective analysis of cases series and literature review. Methods Adult and child patients who were treated for ICS in the Department of Otorhinolaryngology at Sion Hospital, in Switzerland from 2016 to 2020 were included. Their symptoms, medical history, clinical and radiological findings, treatment, and outcome were documented. Results Eight patients (6 males- 2 females) aged from 14 to 88 y.o., were enrolled. None had any previous history of chronic, or recurrent sinusitis. Moreover, very few presented specific rhinological symptoms, but with neurological or other symptoms. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) were used to confirm the diagnosis of all ICS. All types of known intracranial complications were observed in our cohort with a wide range of extension and severity of sinusitis. A multidisciplinary approach with individual treatments was tailored to each patient. Outcomes were favorable in almost all patients with neither recurrence, nor neurological sequels being observed in the follow-up. Only one patient was lost due to fatal complications of advanced lung cancer. Conclusion ICS remain a challenging clinical problem due to substantial associated morbidity and mortality. The incidence of these complications is relatively low. Therapeutical management guidelines are lacking. Early detection and multidisciplinary approach are key to successful treatment.

Temporal Trends in Pediatric Acute Sinusitis Surrounding the COVID‐19 Pandemic

“…Further, adolescent patients are known to be more vulnerable to intracranial complications after acute sinusitis due to the highly vascularized diploic venous system in this age group. However, whether this increased incidence of acute sinusitis cases within the 10‐ to 14‐year age group was coupled with a rise in intracranial complications could not be discerned in this analysis 20 . This high observed incidence of acute sinusitis incidence within this age group should be confirmed with further studies and evaluated along with associated complications as a part of a true change in the pattern of acute sinusitis incidence.…”

Aspectos da Rinossinusite Aguda e suas complicações inerentes

“…Mesmo sendo menos frequentes que as complicações orbitais, têm uma taxa de mortalidade mais elevada. As principais CICs são: os abscessos epidural, subdural e intraparenquimatoso; trombose do seio cavernoso ou sagital superior; e as meningites (HALLAK et al, 2022), que podem ocorrer por extensão do processo sinusal para o sistema nervoso central (SNC), tanto por via hematogênica (quando a infecção atinge uma parte do corpo diferente da localização em que se iniciou), quanto por contiguidade (quando atinge regiões próximas ao sítio inicial de infecção). Dentre os seios envolvidos nas CICs, o seio frontal é o mais comumente comprometido, sendo seguido, respectivamente, pelos seios etmoidal e esfenoidal (DEBOER; KWON, 2022).…”

“…Nas CICs, os pacientes apresentam alguns sintomas em comum, os mais frequentes são: cefaleia, dor retro-orbitária, edema orbitário, edema palpebral, edema facial, exoftalmia, hiperêmese, sonolência e hipertermia (HALLAK et al, 2022). Além desses sintomas, também foram identificadas alterações como paralisia dos nervos cranianos III (oculomotor), IV (troclear) e VI (abducente); hipoestesia ou parestesias; hemiparesia e hemiplegia; convulsões; e, até mesmo, coma (KHULLAR et al, 2022).…”

“…Os tratamentos das CICs vão ser diferentes em cada caso, visto que existem diferentes complicações causadas por diferentes agentes etiológicos. Com isso, o tratamento pode ser feito através de medidas cirúrgicas, por meio do uso de antibióticos ou, também, por meio da terapia antifúngica (HALLAK et al, 2022;NAM et al, 2020).…”

“…As Complicações Intracranianas (CICs) são as mais graves e potencialmente fatais, sendo que o seio frontal é mais frequentemente envolvido nesses casos, mas há apresentações nos seios etmoidal e esfenoidal, porém, são menos comuns que as complicações orbitais. A disseminação infecciosa associada aos seios frontal e esfenoidal ocorre por duas vias: a via venosa hematogênica e/ou anterógrada (HALLAK et al, 2022).…”