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Otogenic Intracranial Abscess
Concurrent Craniotomy and Mastoidectomy—Changing Trends in a Developing Country
Mary Kurien, MS;
Anand Job, MS;
John Mathew, MS;
Mathew Chandy, MS, MCh
Arch Otolaryngol Head Neck Surg. 1998;124:1353-1356.
Objectives To evaluate (1) the clinical profile, treatment, and outcome of adult and pediatric patients presenting with intracranial abscess of otogenic origin and (2) the advantages of concurrent craniotomy and mastoidectomy.
Design A prospective case series.
Setting An academic tertiary referral center in India.
Patients Thirty-six patients clinically diagnosed as having intracranial abscess that was secondary to suppurative otitis media and confirmed by computed tomographic scanning.
Intervention Concurrent craniotomy and mastoidectomy.
Results Children were more commonly affected than adults, and there was a male preponderance. All patients had cholesteatoma at surgery, although one third of the children had only granulation tissue on otoscopy. More than two thirds of the patients in both the groups presented with more than one intracranial complication and definitive surgical intervention was done later than 24 hours. Meningitis was the most frequent intracranial complication, followed by cerebellar abscess. There was no significant intraoperative or postoperative morbidity, mortality, recurrence of intracranial complications, or residual neurological deficits. Three children (14%) showed evidence of recidivism cholesteatoma requiring revision surgery.
Conclusions In suppurative otitis media with intracranial complications, it is accepted practice to treat the neurosurgical complication first, followed by mastoidectomy at a later date after the patient has been stabilized. Craniotomy with concurrent mastoidectomy is not only safe, but it also removes the source of infection at the same time the complications are being treated, thus avoiding reinfection while the patient is awaiting the ear surgery. In addition, the treatment is completed with a single, shorter hospital stay, which is more economical for the patient.
From the Ear, Nose, and Throat Department (Drs Kurien, Job, and Mathew) and the Department of Neurosurgery (Dr Chandy), Christian Medical College and Hospital, Vellore, India.
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