Single stage, transmastoid approach for otogenic intracranial abscess

Abstract

In this series, the low morbidity and mortality rate, combined with a shorter hospital stay, suggest that single stage, transmastoid drainage of intracranial abscess and concurrent treatment of the otogenic pathology is an effective treatment for otogenic intracranial abscess.

Current trends in the management of the complications of chronic otitis media with cholesteatoma

“…However, some authors have reported high incidence of brain abscesses in their series over and above other complications [7,31,38,45]. It is also true that the commonest cause of abscesses in the temporal lobe and cerebellum is chronic ear infection [45,46]. A brain abscess begins when bacteria propagate in and around venous channels leading from the mastoid into the adjacent brain parenchyma.…”

“…The antibiotics therapy is continued for at least 6 weeks with serial imaging follow-up [31,50]. There is a role for conservative management of small abscesses (<1 cm) [45] but surgery has to be done at the earliest opportunity for eradication of cholesteatoma. Once a decision has been taken to drain the abscess, it can be done via mastoidectomy [38,45], open evacuation via craniotomy, excision, aspiration through a burr hole or stereotactic aspiration.…”

Management of Otogenic Brain Abscess Using the Transmastoid Approach

“…In all cases, the recommended course of parenteral antibiotic therapy is 6 to 8 weeks (following aspiration)9). In treating otogenic brain abscesses, the transmastoid approach has the advantage of eradicating the primary source of infection while additionally providing an easily accessible method for abscess aspiration in one or two stages4,10,18).…”

Otitis Media Complications

“…However, some authors recommend other treatments, such as combined early neurosurgery and mastoidectomy, mastoidectomy with evacuation of the abscess through the mastoidectomy; some groups even perform only the mastoidectomy and reserve the neurosurgery only for selected cases. All of these treatments are supported by reports of low and comparable morbidities and mortalities that have decreased, towards 0 % [41,[43][44][45][51][52][53]. Subdural abscess or empyema is an exception to this rule because it requires immediate neurosurgical drainage [41,44,50].…”