Otogenic Intracranial Abscess

Kurien, Mary; Job, Anand; Mathew, John; Chandy, Mathew J.

doi:10.1001/archotol.124.12.1353

Cited by 82 publications

(28 citation statements)

References 13 publications

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“…However, despite such concurrent therapy, a good number of patients may require surgery for recurrence [40]. Thus, all our patients were referred at discharge for elective mastoidectomy or sinus surgery to the otologists.…”

Section: Discussionmentioning

confidence: 99%

Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome

Madhugiri

Sastri

Srikantha³

et al. 2011

Pediatr Neurosurg

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Introduction: Focal intradural infections of the brain include empyema and abscess in the supratentorial and infratentorial spaces. These are amenable to surgical management. Various other issues may complicate the course of management, e.g. hydrocephalus with infratentorial lesions or cortical venous thrombosis with supratentorial lesions. Here, we review the management and identify factors affecting outcome in these patients. Materials and Methods: This is a retrospective analysis of all children (aged <18 years) treated at the National Institute of Mental Health and Neurosciences, Bangalore, India, between 1988 and 2004. Case records were analyzed to obtain clinical, radiological, bacteriological and follow-up data. Results: There were 231 children who underwent treatment for focal intradural abscess/empyema at our institute. These included 57 children with cerebral abscess, 65 with supratentorial empyema, 82 with cerebellar abscess and 27 with infratentorial empyema. All patients underwent emergency surgery (which was either burr hole and aspiration of the lesion or craniotomy/craniectomy and excision/evacuation), along with antibiotic therapy, typically 2 weeks of intravenous and 4 weeks of oral therapy. The antibiotic regimen was empiric to begin with and was altered if any sensitivity pattern of the causative organism(s) could be established by culture. Hydrocephalus was managed with external ventricular drainage initially and with ventriculoperitoneal shunt if warranted. Mortality rates were 4.8% for cerebral abscess, 9.6% for cerebellar abscess, 10.8% for supratentorial subdural empyema and 3.7% for posterior fossa subdural empyema. The choice of surgery was found to have a strong bearing on the recurrence rates and outcome in most groups, with aggressive surgery with craniotomy leading to excellent outcomes with a low incidence of residual/recurrent lesions. Conclusions: Antibiotic therapy, emergency surgery and management of associated complications are the mainstays of treatment of these lesions. We strongly advocate early, aggressive surgery with antibiotic therapy in children with focal intradural infections.

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Section: Discussionmentioning

confidence: 99%

Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome

Madhugiri

Sastri

Srikantha³

et al. 2011

Pediatr Neurosurg

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“…Notably, cholesteatoma is an important risk factor for intracranial complications, as it is present in 78% to 100% COM cases that go on to develop complications5,6,12,13). The basic concepts in treating otogenic brain abscesses include immediate decompression of the abscess, prompt eradication of the primary otogenic nidus, and the active prevention of abscess recurrence.…”

Section: Discussionmentioning

confidence: 99%

Management of Otogenic Brain Abscess Using the Transmastoid Approach

Choi

Kim

2014

J Korean Neurosurg Soc

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Despite significant advances in the treatment of all forms of chronic otitis media (COM), complications still can and do occur, with intracranial complications representing the most life-threatening cases, often requiring immediate therapeutic intervention. Herein, we present a rare case of rapidly progressing facial paralysis with concomitant severe headache and ipsilateral hearing loss secondary to an otogenic brain abscess, treated with the transmastoid approach, drainage, and facial nerve decompression.

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“…The enthusiasm in recent reports in favor of craniotomy with concurrent mastoidectomy [19, 20]must be tempered by the knowledge that the operating time may become inordinately prolonged, extending up to 9 h [19]in this fragile population, in spite of which up to 14% of children may require revision surgery for recurrence [19]. …”

Section: Discussionmentioning

confidence: 99%

Primary Excision of Pediatric Posterior Fossa Abscesses – Towards Zero Mortality?

Agrawal¹,

Suri²,

Mahapatra³

2003

Pediatr Neurosurg

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Nine children with infratentorial brain abscesses were treated at our institution over a 3-year period. Seven of them were boys and two were girls. In five cases, the abscesses were otogenic, and in two cases, the cause was tubercular (including one case of tubercular otitis). There were three cases of abscess formation in dermoids. All cases were managed with primary excision of the abscess. The average hospital stay was 12 days, and there was no mortality. The most common complication was hydrocephalus, noticed in three patients, of whom one eventually required shunt placement. Our policy of primary excision of these abscesses has yielded gratifying results. This approach also resulted in minimal morbidity and a substantially shortened hospital stay. Moreover, primary excision yields definitive histopathology of the lesion, especially in cases of tubercular and dermoid etiologies.

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Otogenic Intracranial Abscess

Cited by 82 publications

References 13 publications

Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome

Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome

Management of Otogenic Brain Abscess Using the Transmastoid Approach

Primary Excision of Pediatric Posterior Fossa Abscesses – Towards Zero Mortality?

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