Spontaneous Cranial Osteomyelitis in an Otherwise Healthy Ten-Year-Old Male

Objectives: Pott's puffy tumor (PTT) is a frontal subperiosteal abscess associated with underlying frontal osteomyelitis. The purpose of the present study was to assess the rate of intracranial involvement in pediatric and adolescent patients with PPT and to discuss the diagnostic workup and the therapeutic features of this pathology.Methods: We searched Web of Science, PubMed and MEDLINE from 1998 to 2018. The search focused on papers concerning the diagnostic procedure and therapeutic management of PTT. Statistical techniques were not used.Results: We included 53 articles that described 92 pediatric and adolescent patients with PPT. The overall rate of intracranial complications was found to be 72%. Most authors used computed tomography for the diagnosis of PTT and its complications, either alone or in combination with magnetic resonance imaging. In 50% of cases, an endoscopic endonasal approach is used for the management of the underlying acute or chronic sinusitis.Conclusions: On the basis of the available literature, it seems that the incidence rate of intracranial involvement in patients with PPT is quite high. Early diagnosis using the appropriate imaging raise the possibility of good recovery. Concerning the therapy of PTT, endoscopic sinus surgery could be considered as a valuable technique. The vast majority of patients treated appropriately recover without long-term neurologic complications and sequelae.

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“…Most of the articles were either case series or case reports. The characteristics of the included studies are summarized in Table …”

Section: Resultsmentioning

confidence: 99%

Pott's puffy tumor in children: A review of the literature

2018

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“…36 Common causes in children are complicated frontal sinusitis, skull base osteomyelitis secondary to ear infection and postsurgical infection. 37 CT demonstrates a lytic permeative pattern of osseous involvement in the acute phase. In the chronic phase, a mixed lytic and sclerotic pattern may be observed.…”

Section: Skull Base Osteomyelitismentioning

confidence: 97%

Imaging of Pediatric Skull Base Lesions

Chandra¹,

Maheshwari²,

Kelly³

et al. 2015

neurograph

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“…In children, three origins for cranial osteomyelitis appear to dominate: Pott's puffy tumor, skull base osteomyelitis secondary to ear infection, or postsurgical complications. However, on extremely rare occasions, risk factors or etiology may not be ascertained (Arnold et al, 2009). Arnold et al (Arnold et al, 2009) reported a case of spontaneous cranial osteomyelitis in an otherwise healthy child.…”

Section: Spontaneous Cranial Osteomyelitis In An Otherwise Healthy Childmentioning

confidence: 99%

“…However, on extremely rare occasions, risk factors or etiology may not be ascertained (Arnold et al, 2009). Arnold et al (Arnold et al, 2009) reported a case of spontaneous cranial osteomyelitis in an otherwise healthy child.…”

Section: Spontaneous Cranial Osteomyelitis In An Otherwise Healthy Childmentioning

confidence: 99%

Skull Osteomyelitis

Soo¹

2012

Osteomyelitis

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Bone lesions resembling tertiary syphilis caused by Treponema pallidum or another of the treponematoses have been observed in nearly every Andean culture from Peru and Chile, dating back nearly 8000 years (Gerstzen et al., 1998). The lesions are similar in each case, with periostitis, osteitis, and osteomyelitis attacking the skull and the long bone, particularly the tibia. This tibial involvement results in the classic "saber shin". Several of the skulls observed with such lesions had been "treated" during life by repeated trephination using a scraping technique. 2.1.2 Greek and early Byzantine period The intellectual evolution of neurological surgery originated in the golden age of Greece with the founding of the Alexandrian school in 300 BC. Because of both sporting injuries, in particular gladiator injuries, and wars, head injuries appear to have been plentiful, and provided opportunities to develop neurosurgical skills (Goodrich & Flamm, 2011). In this early era of medicine, the risk of infection, lack of antiseptic technique, and minimal anesthesia prevented generations of surgeons from performing any serious or aggressive surgical intervention for head injury (Goodrich & Flamm, 2011). Galen of Pergamon (AD 129-200) detailed a safer and more reliable use of the trephine, and in particular argued for continuous irrigation during trephination to avoid delivering excessive heat and injury to the underlying brain (Goodrich, 2005). Paul of Aegina (AD 625-690), trained in the Alexandrian school, was the last great Byzantine physician. His wound management was quite sophisticated for prevention of infection. He used wine (helpful in antisepsis, although this concept was then unknown) (Goodrich, 2005). 2.1.3 Medieval Europe Inventive medieval surgeon Theodoric Borgognoni of Cervia (1205-1298) is remembered as a pioneer in the use of the aseptic technique-not the "clean" aseptic technique of today, but rather a method based on avoidance of "laudable pus". He attempted to discover the ideal conditions for good wound healing, and concluded that they comprised control of bleeding, removal of contaminated or necrotic material, avoidance of dead space, and careful application of a wound dressing bathed in wine (Goodrich & Flamm, 2011). Control of bleeding, removal of contaminated or necrotic material, and avoidance of dead space are principles that can also apply in today's neurosurgical operations. He also argued for primary closure of all wounds when possible and avoiding "laudable pus" (Goodrich & Flamm, 2011). Lanfranchi of Milan (1250-1306) noted that the head should be shaved prior to surgery to prevent hair from getting into the wound and interfering with primary healing. Today, most neurosurgeons also shave hair before an operation. However, the time of shaving is currently controversial. When dealing with depressed skull fractures, Lanfranchi advocated putting wine into the depression to assist healing (Goodrich & Flamm, 2011). Guy de Chauliac (1300-1368) was clearly the most influential European surgeon of the ...

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Spontaneous Cranial Osteomyelitis in an Otherwise Healthy Ten-Year-Old Male

Cited by 11 publications

References 17 publications

Pott's puffy tumor in children: A review of the literature

Pott's puffy tumor in children: A review of the literature

Imaging of Pediatric Skull Base Lesions

Skull Osteomyelitis

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