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John A. Germiller, MD, PhD; Daniel L. Monin, MD; Anthony M. Sparano, MD; Lawrence W. C. Tom, MD

Arch Otolaryngol Head Neck Surg. 2006;132:969-976.

Objective  To gain insight into patterns of presentation, imaging, microbiological aspects, therapy, disease course, and outcome of intracranial complications of sinusitis (ICS), which are challenging conditions with the potential to cause significant morbidity and mortality. We reviewed our experience with ICS in children and adolescents.

Design  Consecutive case series with a mean follow-up of 12 months.

Setting  Tertiary pediatric referral center.

Patients  Consecutive sample of 25 children and adolescents treated for 35 intracranial complications (mean age, 13.2 years [range, 4-18 years]).

Interventions  Medical and surgical management.

Main Outcome Measures  Survival and temporary and permanent neurologic sequelae.

Results  Most patients were adolescents (n = 19; 76%) and male (n = 19; 76%). Epidural abscess was most common (13 complications), followed by subdural empyema (n = 9), meningitis (n = 6), encephalitis (n = 2), intracerebral abscess (n = 2), and dural sinus thrombophlebitis (n = 2). Abscesses were primarily located in the frontal or frontoparietal regions. Magnetic resonance imaging was extensively used and was superior to contrast computed tomography in diagnosis. All patients received intravenous antibiotics, 21 underwent endoscopic sinus surgery, and 13 underwent neurosurgical drainage. Only 1 death occurred from sepsis secondary to meningitis (mortality, 4%). Overall, neurologic outcome was excellent. Although 10 patients (40%) had neurologic deficits, most resolved within 2 months. Only 2 patients had permanent neurologic sequelae. Among ICS, epidural abscess appeared to be a distinct clinical entity. Epidural abscesses typically presented without specific neurologic symptoms or signs, were more often associated with orbital complications, and had outcomes considerably better than the other ICS.

Conclusion  Intracranial complications of sinusitis are challenging, but prognosis can be favorable in children and adolescents by using aggressive medical and surgical management.

Author Affiliations: Division of Pediatric Otolaryngology, The Children's Hospital of Philadelphia, and Department of Otorhinolaryngology, University of Pennsylvania, Philadelphia.