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Review of management practices of sinogenic intracranial abscesses in children

Published online by Cambridge University Press:  08 February 2023

K Milinis ,
J Thiagarajan Open the ORCID record for J Thiagarajan [Opens in a new window] ,
S Leong ,
S De ,
A Sinha ,
R Sharma  and
S Sharma
K Milinis*
Affiliation:
Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
J Thiagarajan
Affiliation:
Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK School of Medicine, University of Liverpool, Liverpool, UK
S Leong
Affiliation:
Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
S De
Affiliation:
Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
A Sinha
Affiliation:
Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
R Sharma
Affiliation:
Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
S Sharma
Affiliation:
Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
*
Corresponding author: Dr K Milinis; Email: miliniskristijonas@gmail.com
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Abstract

Objective

This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration.

Method

This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months.

Results

A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes.

Conclusion

Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.

Keywords

Sinusitissubdural empyemaepidural abscessbrain abscessendoscopic sinus surgery
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 10 , October 2023 , pp. 1135 - 1140
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr K Milinis takes responsibility for the integrity of the content of the paper

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