Subdural Abscess Complicating Frontal Sinusitis

Ray, Bronson S.; Parsons, Herbert

doi:10.1001/archotol.1943.00670030548007

Cited by 23 publications

(4 citation statements)

References 9 publications

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“…Analysis of the literature shows that without the administration of antibiotics in intracranial complications of sinusitis, mortality was very high (80–100%) [ 23 – 25 ]. The use of next-generation antibiotics, new imaging methods (MRI and CT), the perfection of sinus surgery techniques (FESS), the development of surgical methods for the base of the skull and the use of neuronavigation all played a significant role in decreasing mortality rates, which are currently between 7 and 15% [ 3 , 6 , 8 , 9 , 26 – 28 ].…”

Section: Discussionmentioning

confidence: 99%

Simultaneous treatment of intracranial complications of paranasal sinusitis

Szyfter

Bartochowska

Borucki

et al. 2018

Eur Arch Otorhinolaryngol

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PurposeThe objective of this study was to analyse 51 patients with intracranial complications of sinusitis treated in the Department of Otolaryngology and Laryngeal Oncology at Poznań University of Medical Sciences from 1964 to 2016.Materials and methodsMales made up a significant portion of study participants at 70.5%. Treatment included simultaneous removal of inflammatory focal points in the paranasal sinuses and drainage of cerebral and epidural abscesses and subdural empyemas under the control of neuronavigation preceded by the implementation of broad-spectrum antibiotics continuously for 4 weeks. Seventy-three intracranial complications were found among 51 patients. Of the 51 patients, 25 had frontal lobe abscesses (including multiple abscesses). Other complications included the following: 16 epidural abscesses, 9 subdural empyemas, 15 meningitis cases, 3 intracerebral abscesses, 3 sinus thrombosis cases and 2 patients with cerebritis. Co-occurrence of these complications worsened the state of the patient and increased the duration of treatment. Patients with frontal lobe abscesses had a better prognosis and less pronounced neurological symptoms in recent years versus earlier treatment approaches.ConclusionsSimultaneous treatment of intracranial complications of sinusitis is an effective treatment method that has minimal burden for the patient. From 1964 to 1978, three deaths (17%) were reported among patients with these complications. Since 1978, no deaths were reported in the clinic.

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Section: Discussionmentioning

confidence: 99%

Simultaneous treatment of intracranial complications of paranasal sinusitis

Szyfter

Bartochowska

Borucki

et al. 2018

Eur Arch Otorhinolaryngol

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“…On the other hand sinusitis is the most frequent cause of subdural empyema with Wood (1952) and Sable et al (1984) reporting sinusitis as the cause in 82 per cent of patients, Schiller et al (1948) and Bannister et al (1981) 69 per cent, Bhandari and Sarkari (1970) 54 per cent, Hoyt and Fisher (1991) 53 per cent. The mortality from subdural empyema in the preantibiotic era was 100 per cent (Kubik and Adams, 1943;Ray and Parsons, 1943;Courville, 1944). With the introduction of antibiotics, the mortality decreased, but has remained high, ranging between 30 and 40 per cent (Wood, 1952;Hitchcock and Andreadis, 1964;Bhandari and Sarkari, 1970;Farmer and Wise, 1973;Kaufman et al, 1975).…”

Section: Discussionmentioning

confidence: 99%

“…Purulent sinusitis can be considered a life-threatening disease because of the intracranial complications associated with it. In the pre-antibiotic era, the mortality from intracranial sepsis was between 80 and 100 per cent (Kubik and Adams, 1943;Ray andParsons, 1943, Courville, 1944;Ballantine and White, 1953). With the introduction of antibiotics, the mortality halved, but remained high, ranging between 27 and 53 per cent (Jooma et al, 1951;Wright and Ballantine, 1967;Garfield, 1969).…”

Section: Introductionmentioning

confidence: 99%

Sinogenic intracranial complications

et al. 1995

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Two hundred and nineteen patients, with intracranial complications of sinusitis, are presented. Sinusitis is still a life-threatening condition and if neglected, or mismanaged, can lead to intracranial complications that result in a high mortality and morbidity.Twenty-two patients had meningitis, 127 subdural empyema, 38 brain abscess, 15 combined brain abscess and subdural empyema and 17 extradural empyema. The diagnosis of intracranial abscess and sinusitis was made with the aid of a CT scan, and that of meningitis on cerebrospinal fluid microscopy, chemistry and culture. The most frequent presenting signs were fever (68 per cent) and headache (54 per cent). The most common localizing neurological sign was hemiparesis (35.5 per cent). Orbital inflammation was present in 41.5 per cent of patients.Treatment entailed immediate, appropriate, intravenous antibiotic therapy and prompt surgery, performed within 12 hours of admission. In patients with meningitis, the surgery entailed surgery of the sinus disease only. In patients with subdural empyema, brain abscess and extradural empyema, evacuation of the primary source of infection by the radical frontoethmoidectomy approach, immediately after drainage of the intracranial collection of pus, was carried out.There were 35 deaths (16 per cent). The highest mortality rate was recorded in patients with meningitis (45 per cent) followed by brain abscess (19 per cent) and subdural empyema (11 per cent). Despite advances in medicine, i.e. antibiotics and CT scan for early and accurate diagnosis, the mortality from sinogenic intracranial complications has remained significant. This can only be eliminated through education. This paper emphasizes to younger generations of otolaryngologists and primary care physicians that sinusitis is a serious disease and there is no place for delay or complacency when managing such patients.

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“…Analysis of the literature shows that before the antibiotic's era, mortality from ICS was very high. 48,49 Thanks to the new imaging methods (CT and MRI), the use of the nextgeneration antibiotics, the perfectioning of the sinus surgery skills (FESS), the development of surgical skull-base approaches and the use of neuronavigation system all played a significant role in decreasing mortality rates, which are currently between 7% and 15%. 17,23,46,50,51 Our cohort represents almost all known types of ICS.…”

Section: Discussionmentioning

confidence: 99%

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

Hallak

Bouayed

Ghika

et al. 2022

Allergy�Rhinol (Providence)

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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.

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Subdural Abscess Complicating Frontal Sinusitis

Cited by 23 publications

References 9 publications

Simultaneous treatment of intracranial complications of paranasal sinusitis

Simultaneous treatment of intracranial complications of paranasal sinusitis

Sinogenic intracranial complications

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

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