Single-Stage Trans-mastoid Drainage of Otogenic Brain Abscess: A Single-Institution Experience

Abstract

Brain abscess is the ultimate otogenic complication, both in severity and difficulty of management. In developing countries with high incidence of cholesteatoma, brain abscess is not a rare complication. In India, brain abscesses constitute about 8 % of all intracranial lesions. The surgical treatment of brain abscess is very controversial. This prospective study was done in ENT department of a tertiary care hospital in Kolkata, during the period from May 2009 to April 2014. 22 such cases of otogenic brain abscess managed by single-stage trans-mastoid drainage along with meticulous mastoid clearance. On the basis of clinical, radiological and operative findings, data of all patients with otogenic brain abscess were analyzed. There was male predominance and 9 (40.91 %) of them were younger than 20 years. 15 (68.18 %) cases were of cerebellar abscess and in 7 (31.82 %) cases were of the temporal abscess. Lateral sinus thrombosis was the most common associated complication found (22.73 %) in our study. All the patients peri-operatively revealed cholesteatoma. All the patients recovered well and there was no recurrence of symptoms on a minimum 15 months followup. This approach suits the otologists in clearing the cause and effect of pathology, at the same sitting. This singlestage approach decreases the peri-operative morbidity and mortality of the two-stage procedure. It also decreases the hospital stay and financial burden.

Identification of Risk Factors for Mortality and Prolonged Hospitalization in Patients Treated With Surgical Drainage for Otogenic Intracranial Complications: A Nationwide Study Using a Japanese Inpatient Database

“…Multiple logistic regression analysis was performed to compare multiple outcome categories, assessing the independent effect on the severity of intracranial complications. Inclusion of independent variables in the model was based on earlier research and existing knowledge in terms of the following risk factors for aggravation of intracranial complication and abscesses in the head and neck region (2)(3)(4)(5)11,14,21): age, sex, pathogenesis (cholesteatoma or other otitis media), type of complication (subdural abscess including cerebral abscess or other intracranial complications such as epidural abscess or meningitis), level of consciousness evaluated by the JCS, comorbid DM and sepsis, and repeated surgical interventions.…”

Absceso cerebral. Reporte de caso

“…La disfunción de la trompa de Eustaquio, las entidades que causan la compresión de la trompa de Eustaquio, la obstrucción de su salida o una anomalía de la respuesta inmunológica del huésped pueden ser factores predisponentes en el desarrollo de esta patología. En el caso clínico, el antecedente de embarazo sin controles prenatales y los cambios inmunológicos durante la gestación se consideraron factores de riesgo para el desarrollo de otitis supurativa y la consiguiente complicación y desarrollo de absceso cerebral [4][5][6][7][8][9] .…”

“…temprana de 1 a 3 días, cerebritis tardía de 4 a 9 días, absceso temprano de 10 a 13 días y absceso tardío mayor a 14 días.El absceso tardío se caracteriza por la maduración de la cápsula y el depósito de colágeno, condición importante para limitar la diseminación de la infección; este proceso está influenciado por la resistencia inmune del huésped, duración de la infección, microorganismo causante y tratamiento[7][8][9][10] .En la TAC del absceso temprano y tardío se puede apreciar un área hipodensa redonda, ovalada o multiloculada con realce anular (Imagen Nº 1). En la RNM la cavidad del absceso es hipointensa en T1, hiperintenso en T2.…”

“…En la secuencia de difusión, el absceso piógeno típicamente presenta una intensa restricción con valores de ADC bajos. La difusión restringida en los abscesos se cree que puede ser debido al resultado de la relativamente alta viscosidad y la celularidad de pus[7][8][9][10][11] .…”