Introduction
Acute bacterial rhinosinusitis is common in children and adolescents and is frequently self-limiting. However, in a small proportion of patients (3.9%) sinusitis can be complicated by intracranial abscesses namely subdural empyema (SDE), intraparenchymal abscess (IPA) and extradural abscess (EDA)[1]. The spread of infection occurs either via direct extension (e.g. frontal bone osteomyelitis) or haematogenous dissemination of bacterial pathogens from the paranasal sinuses[2]. Children may present with non-specific symptoms such as malaise, headaches and fevers, which can result in a delay of correct diagnosis and subsequently worse outcomes[3]. Previous studies have reported significant morbidity with around half of patients requiring revision surgery, a quarter experiencing neurological disability and a mortality of 3-10%[4–6].
Optimal treatment of sinogenic intracranial suppuration in children is a contentious issue. A number of studies have reported the results of various treatment strategies; however, the evidence base is largely restricted to small retrospective case series[7–11]. The majority of the patients undergo either sinus drainage procedures or neurosurgical interventions or the combination of the two[3]. In addition, in a small proportion of patients a conservative medical treatment has also been reported[12]. The question of how extensive or aggressive the initial treatment strategy needs to be however remains unanswered. While some studies advocate joint interventions addressing both sinus and intracranial suppuration, others report that sinus surgery alone alongside antibiotic therapy may be sufficient to avoid a craniotomy[9,13,14]. However, due to the limited sample sizes and a lack of direct comparisons between the treatment arms, it is currently not clear which treatment strategies achieve the most favourable outcomes.