Abstract
Objectives: To evaluate the management practices and outcomes
in children with sinogenic intracranial suppuration.
Design: Retrospective cohort study.
Setting: A single paediatric tertiary unit.
Participants: Patients younger than 18 years with
radiologically confirmed intracranial abscess including subdural empyema
(SDE), epidural (EDA) or intraparenchymal (IPA) abscess secondary to
sinusitis.
Main outcome measures: The rates of return to theatre, the
length of hospital stay (LOS), death <90 days and neurological
disability (ND) at 6 months.
Results: A cohort of 39 consecutive patients (41% male, mean
age 11.5) presenting between 2000-2020 were eligible for inclusion. SDE
was the most common intracranial complication (n=25, 64%) followed by
EDA (n=12, 31%) and IPA (n=7, 18%). The mean LOS was 42 days (SD 16).
Sixteen patients (41%) were managed with combined ENT and neurosurgical
interventions, 15 (38.5%) underwent ENT procedure alone and 4 (10.3%)
had neurosurgical only drainage. Four patients initially underwent
non-operative management. The rates of return to theatre, ND and 90-day
mortality were 19 (48.7%), 9 (23.1%) and 3 (7.7%) respectively and
were comparable across the four treatment arms. In the univariate
logistic regression, only the size of an intracranial abscess (≥10mm)
was found be associated with an increased likelihood of return to
theatre (odds radio 7, confidence interval 1.09-45.1), while combined
ENT and neurosurgical intervention did not result in improved outcomes.
Conclusion: Sinogenic intracranial abscesses are associated
with a significant morbidity and mortality. The size of an intracranial
abscess has a strong association with a need for a revision surgery.
Key words: sinusitis, subdural empyema, epidural abscess, brain
abscess, endoscopic sinus surgery