Letters to the Editor

PEDIATRICS ◽  
1981 ◽  
Vol 68 (3) ◽  
pp. 465-466
Author(s):  
Itzhak Brook
Keyword(s):  
Antimicrobial Therapy ◽  
Surgical Drainage ◽  
Intracranial Abscess ◽  
Letters To The Editor ◽  
Ample Evidence ◽  
Complete Cure ◽  
Intracranial Complications

There is ample evidence to indicate that administration of antimicrobial therapy alone to patients with intracranial abscess can result in neurologic deterioration1 and higher mortality.2 In our article entitled "Complications of Sinusitis in Children" we described the occurrence of intracranial complications following sinusitis.3 Surgical drainage accompanied by antimicrobial therapy resulted, eventually, in complete cure of all of our patients. However, three out of four of our patients with intracranial abscess initially did not respond to appropriate antimicrobial therapy directed against the organisms recovered from their abscesses.

Intracranial Complications of Sinusitis in Children

1982 ◽  
Vol 91 (1) ◽  
pp. 41-43 ◽  
Author(s):  
Itzhak Brook ◽  
Ellen M. Friedman
Keyword(s):  
Brain Abscess ◽  
Antimicrobial Therapy ◽  
Anaerobic Bacteria ◽  
The Other ◽  
Surgical Drainage ◽  
Intracranial Abscess ◽  
Periapical Abscess ◽  
Intracranial Complications ◽  
Maxillary Sinuses

The cases of two children with periapical abscess in the upper incisors, sinusitis, and intracranial abscess are described. The ethmoid and maxillary sinuses were involved in both patients. Subdural empyema occurred in both, and one of the children had also cerebritis and brain abscess. Anaerobic bacteria were isolated from the infected subdural empyemas. Peptostreptococcus intermedius and microaerophilic streptococci were recovered in one patient and Fusobacterium sp in the other. Surgical drainage and appropriate antimicrobial therapy resulted in complete eradication of the infection in both patients. The role of anaerobic bacteria and the therapy directed against them in periapical abscess and the sinusitis and intracranial abscess which follow are discussed.

Intracranial Complications of Sinusitis in Childhood

1995 ◽  
Vol 104 (4) ◽  
pp. 288-293 ◽  
Author(s):  
Don N. Lerner ◽  
George H. Zalzal ◽  
Sukgi S. Choi ◽  
Dennis L. Johnson
Keyword(s):  
Medical Center ◽  
Abscess Formation ◽  
Intracranial Extension ◽  
Washington Dc ◽  
Surgical Drainage ◽  
Intracranial Abscess ◽  
National Medical ◽  
Management Protocol ◽  
Similar Disease ◽  
Intracranial Complications

Complications of sinusitis in children, such as intracranial abscess formation, are uncommon and are often clinically unremarkable in comparison to similar disease processes in adults. Between 1983 and 1991, 443 children were admitted to Children's National Medical Center in Washington, DC, for treatment of sinusitis. Fourteen of these children presented with intracranial extension of the infection and abscess formation. A retrospective review of these patients revealed that the risk of developing an intracranial abscess secondary to sinusitis was 3%. The management of these patients included surgical drainage of the infected sinuses and intracranial surgical exploration. Cranialization and exenteration of the frontal sinus proved to be effective single-stage procedures. While not indicated in all patients, these procedures eliminated the sinus as a source of continued or potential infection and obviated the need for a second obliterative procedure. Combined antimicrobial therapy and surgical drainage should be the management protocol.

Frontal Sinus Drainage in Acute Pediatric Sinusitis With Intracranial Complications

2021 ◽  
pp. 194589242199131
Author(s):  
Stephen R. Chorney ◽  
Adva Buzi ◽  
Mark D. Rizzi
Keyword(s):  
Surgical Procedures ◽  
Frontal Sinus ◽  
Case Series ◽  
Primary Objective ◽  
Acute Sinusitis ◽  
Intracranial Abscess ◽  
Repeat Surgery ◽  
Initial Surgery ◽  
Intracranial Complications ◽  
Sinus Drainage

Background The indication for frontal sinus drainage is uncertain when managing pediatric acute sinusitis with intracranial complications. Objective The primary objective was to determine if addressing the frontal sinus reduced need for subsequent surgical procedures in children presenting with acute sinusitis complicated by intracranial abscess. Methods A case series with chart review was performed at a tertiary children’s hospital between 2007 and 2019. Children under 18 years of age requiring surgery for complicated acute sinusitis that included the frontal sinus with noncontiguous intracranial abscess were included. Outcomes were compared among children for whom the frontal sinus was drained endoscopically, opened intracranially, or left undrained. Results Thirty-five children with a mean age of 11.1 years (95% CI: 9.9-12.3) met inclusion. Most presented with epidural abscess (37%). Hospitalizations lasted 12.9 days (95% CI: 10.2-15.5), 46% required a second surgery, 11% required three or more surgeries, and 31% were readmitted within 60 days. Initial surgery for 29% included endoscopic frontal sinusotomy, 34% had a frontal sinus cranialization and 37% did not have any initial drainage of the frontal sinus. Groups were similar with respect to demographics, severity of infection, need for repeat surgery, length of stay, and readmissions (p > .05). Further, persistence of cranial neuropathies, seizures, or major neurological sequelae after discharge were no different among groups (p > .05). Conclusion Drainage of the frontal sinus, when technically feasible, was not associated with reduced surgical procedures or increased complications and there is unclear benefit on measured clinical outcomes.

INTRACRANIAL COMPLICATIONS OF CONGENITAL DERMAL SINUSES

PEDIATRICS ◽  
1951 ◽  
Vol 8 (4) ◽  
pp. 463-474
Author(s):  
DONALD D. MATSON ◽  
FRANC D. INGRAHAM
Keyword(s):  
Surgical Treatment ◽  
Intracranial Extension ◽  
Dermal Sinus ◽  
Skull Defect ◽  
Complete Cure ◽  
Neural Axis ◽  
Intracranial Complications ◽  
Subcutaneous Mass ◽  
Sinus Opening ◽  
Congenital Dermal Sinus

Ten patients are presented in whom intracranial extension of a congenital dermal sinus was disclosed by operation. The complications of this lesion include infection in the form of meningitis, abscess formation and osteomyelitis as well as hydrocephalus due to obstruction of the spinal fluid pathways. In unexplained meningitis, the entire midline area of skin over the neural axis should be examined carefully for evidence of a dermal sinus opening. Whenever a dimple or subcutaneous mass is found in the midline of the scalp, RGs should be examined carefully for an underlying skull defect. When such a defect exists, intracranial exploration is indicated. Surgical treatment previous to development of intracranial infection is relatively simple and should be rewarded by complete cure. Excision after infection has occurred is difficult and the results in this group have been poor.

scholarly journals Outcomes of endoscopic sinus surgery for sinusitis-induced intracranial abscess in patients undergoing neurosurgery

2019 ◽  
Vol 47 (2) ◽  
pp. E12 ◽  
Author(s):  
Megumi Koizumi ◽  
Miho Ishimaru ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Tatsuya Yamasoba ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Length Of Stay ◽  
Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Neurosurgical Procedures ◽  
Fungal Sinusitis ◽  
Intracranial Abscess ◽  
Diagnosis Procedure Combination ◽  
Intracranial Complications ◽  
Orbital Complications

OBJECTIVEAlthough sinusitis-induced intracranial complications rarely occur in the current era of antibiotics, they can induce neurological symptoms or death. The authors of this study investigated the association between endoscopic sinus surgery (ESS) and outcomes in patients who had undergone neurosurgical procedures for sinusitis-induced intracranial abscess.METHODSThe authors obtained data on patients with sinusitis-induced intracranial abscess from the Japanese Diagnosis Procedure Combination inpatient data for the period from 2010 to 2017. They excluded patients with fungal sinusitis, orbital complications, immunodeficiency, and malignant disease. They also excluded patients who had received antifungal agents, chemotherapy, immunosuppressants, and antidiabetic drugs. Eligible patients were divided into those with and those without neurosurgical procedures. Propensity score–adjusted regression analyses were performed to examine the association between ESS within the same hospitalization and outcomes (mortality, blood transfusion, readmission, revision neurosurgery, and length of stay).RESULTSOf the 552 potentially eligible patients, 255 were treated with neurosurgical procedures, including 104 who underwent ESS within the same hospitalization and 151 who did not. ESS was not significantly associated with mortality (OR 0.54, 95% CI 0.05–5.81, p = 0.61), blood transfusion (OR 1.95, 95% CI 0.84–4.51, p = 0.12), readmission (OR 0.86, 95% CI 0.34–2.16, p = 0.75), revision neurosurgery (OR 0.65, 95% CI 0.24–1.74, p = 0.39), or length of stay (percent difference −10.8%, 95% CI −24.4% to 5.1%, p = 0.18).CONCLUSIONSThe present study suggests that ESS may not have significant benefits with respect to reducing mortality, blood transfusion, readmission, revision neurosurgery, or length of stay.

scholarly journals 1523. Clinical Epidemiology of Children with Orbital Cellulitis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S554-S555
Author(s):  
Meghna Sharma ◽  
Alexandra Espinel ◽  
Emily Ansusinha ◽  
Rana F Hamdy
Keyword(s):  
Clinical Epidemiology ◽  
Medical Center ◽  
Orbital Cellulitis ◽  
Surgical Drainage ◽  
Medical Problems ◽  
Duration Of Symptoms ◽  
National Medical ◽  
Intracranial Complications ◽  
Almost All ◽  
Viridans Group Streptococci

Abstract Background The microbiology of pathogens causing orbital cellulitis in children is evolving over time, with studies from around 10 years ago describing MRSA as responsible for anywhere from 0 to 13% of cases of orbital cellulitis. However, the prevalence of community-acquired MRSA infections has declined over the past decade. A current understanding of the bacteria most commonly found to be responsible for orbital cellulitis would be important to inform the empiric antibiotic regimens for cases of orbital cellulitis in which no microbiologic data are available. Methods This is a single-center retrospective cohort study of children ≤18 years hospitalized with orbital cellulitis at Children’s National Medical Center between January 1, 2017 and July 31, 2018. We excluded children with immunocompromising conditions, cystic fibrosis, underlying craniofacial abnormality, or recent craniofacial or otolaryngologic surgery. Baseline clinical characteristics, microbiologic data, clinical outcomes, and antibiotic treatment data were abstracted through structured chart review and summarized with descriptive statistics. Results We identified 68 children that met inclusion criteria, with an average age of 8.2 years; 66.2% were male, 48.5% were African American, and 14.7% were Hispanic. Most (67.6%) had no underlying medical problems, 14.7% had asthma, and 22.1% had allergic rhinitis. The median duration of symptoms prior to presentation was 4 days. An abscess or phlegmon was identified in 41 of the 68 (60.3%). Three patients (4.4%) developed intracranial complications. About one-quarter (27.9%) of all patients in the cohort underwent surgical drainage. The most commonly identified pathogens were viridans group streptococci (7/19, 36.8%), followed by Staphylococcus aureus (4/19, 21.1%). Anti-MRSA therapy was provided empirically in almost all (95.6%) of patients. Conclusion One-quarter of all patients hospitalized for orbital cellulitis underwent surgical drainage, and viridans group streptococci and S. aureus were the most commonly isolated pathogens. While MRSA was isolated in only one patient (5.2%), almost all received empiric anti-MRSA therapy. Disclosures All authors: No reported disclosures.

scholarly journals Concomitant orbital and intracranial abscess

2020 ◽  
pp. 189-194
Author(s):  
Andreea Nae ◽  
Stephen Farrell ◽  
Kieron Sweeney ◽  
Siobhan Hoare ◽  
Michael Colreavy
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Pediatric Population ◽  
Sinus Surgery ◽  
Intracranial Abscess ◽  
Case Presentation ◽  
Intravenous Antibiotics ◽  
Intracranial Complications ◽  
Life Threatening ◽  
Team Setting ◽  
Periorbital Swelling

Background:  Intracranial and orbital abscesses in combination together are rare complications of sinusitis. They can be life-threatening and can result in multiple sequelae. Case presentation: A 9-year-old female presented with left periorbital swelling, gaze restriction and headache. Following scans, she underwent emergency endoscopic sinus surgery, evacuation of the intraorbital empyema and stereotactic mini-craniectomy with the evacuation of the extradural empyema as a joint case. The patient recovered well and was discharged to complete intravenous antibiotics for 6 weeks. Conclusion: In the pediatric population intracranial complications of acute sinusitis can have more devastating consequences. Therefore prompt recognition and management are essential within a multidisciplinary team setting. We also highlight the rarity of concomitant multi-site abscess formation and the need to be vigilant for same.

scholarly journals Orbital and intracranial complications after acute rhinosinusitis

2010 ◽  
Vol 48 (4) ◽  
pp. 457-461
Author(s):  
Jan Kastner ◽  
Milos Taudy ◽  
Jiri Lisy ◽  
Paul Grabec ◽  
Jan Betka
Keyword(s):  
Rare Complication ◽  
Clinical Situation ◽  
Intracranial Abscess ◽  
Acute Rhinosinusitis ◽  
Cerebral Pathology ◽  
Intracranial Complications ◽  
Underlying Mechanisms ◽  
Orbital Complication ◽  
The Brain

Background/objectives: Nowadays, intracranial abscess is a rare complication of acute rhinosinusitis. The consequent orbital and intracranial complications of acute rhinosinusitis are rare but must be mutually excluded in complicated rhinosinusitis even when proper surgical and medical treatment tend to efficiently heal the orbital complication. Methods: We report a case of a patient who primarily revealed symptoms of orbitocellulitis as a complication of odontogenous rhinosinusitis. Proper diagnostic and therapeutical measures were undertaken to manage the disease immediately after stationary admission. Results: Two weeks after an inconspicuous healing period, hemiparesis due to formation of an intracranial abscess developed. An emergent situation reveals which was unusual to the clinical situation. Conclusion: The possible role of underlying mechanisms of intracranial abscess formation is discussed and review of literature concerning orbital and intracranial rhinosinusitis complications is performed. The correct indication of imaging methods and accurate evaluation of diminutive symptoms are essential. We assume that performance of a complementary CT of the brain or MRI even when previous CT scan of the orbit/paranasal sinuses reveals no cerebral pathology should be done to avoid or minimize future patients with consecutive orbital and intracranial complications of acute rhinosinusitis.

Letters to the Editor

PEDIATRICS ◽  
1981 ◽  
Vol 67 (6) ◽  
pp. 938-938
Author(s):  
Vincent A. Fulginiti
Keyword(s):  
Early Childhood ◽  
Haemophilus Influenzae ◽  
Antimicrobial Therapy ◽  
Adult Life ◽  
The Other ◽  
Letters To The Editor ◽  
Newborn Period

Dr Macknin's point is well taken. Infection with Haemophilus influenzae has extended up and down the age spectrum, from the newborn period into adult life. Even though the other pyogenic organisms are predominant pathogens beyond early childhood, H influenzae must be considered and antimicrobial therapy adjusted for its potential presence. I'm appreciative of his constructive suggestion modifying my statement in the commentary.

scholarly journals Acute MRSA Sinusitis with Intracranial Extension and Marginal Vancomycin Susceptibility

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Parvathi S. Kumar ◽  
Kenji M. Cunnion
Keyword(s):  
Staphylococcus Aureus ◽  
High Risk ◽  
Inhibitory Concentration ◽  
Treatment Options ◽  
Subsequent Development ◽  
Intracranial Extension ◽  
Surgical Drainage ◽  
Intracranial Abscess ◽  
Acute Bacterial Sinusitis ◽  
Rifampin Resistance

Methicillin resistantStaphylococcus aureus(MRSA) is increasingly being described as a cause of acute sinusitis. We present a patient with acute MRSA sinusitis complicated by rapid intracranial extension, marginal vancomycin susceptibility (MIC = 2 mg/L), delayed drainage of intracranial abscess, and subsequent development of rifampin resistance. Given the relatively high risk of intracranial extension of severe acute bacterial sinusitis and high mortality associated with invasive MRSA infections, we suggest early surgical drainage of intracranial abscesses in these circumstances. We believe this is important given the limited intracranial penetration of currently available treatment options for MRSA, especially those with a vancomycin minimal inhibitory concentration (MIC) of ≥2 mg/L.

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