Intracranial complications of sinusitis (ICS) (cerebral, epidural, and
subdural abscesses, meningitis, and dural sinus thrombophlebitis) rem
ain a challenging and contemporary topic. The progressive pneumatizati
on and continued development of the sinuses after birth and the late a
ppearance of the frontal and sphenoid sinuses imply that some infectio
ns would not appear until later childhood. We reviewed the records at
a large pediatric hospital between 1986 and 1995 and found 10 children
with 13 ICS (cerebral abscess, 5; extra-axial empyema, 5; and meningi
tis, 3). Of 43 children with cerebral abscess and 16 with extra-axial
abscesses treated in this period, 12% of cerebral and 63% of extra axi
al abscesses were due to a sinogenic source. Multiple intracranial and
extracranial complications of sinusitis in a single patient were comm
on. The average age of children with ICS was 12.2 years old. We presen
t these 10 cases and discuss their presentation, microbiology, and cli
nical course. Although the majority presented with a classic picture o
f headache, altered mental status, and fever; a few had symptoms that
were more subtle. One child had recurrent meningitis, believed to be d
ue to skull base dehiscence after endoscopic sinus surgery (ESS). He h
as required multiple otolaryngologic and neurosurgical procedures in a
n effort to prevent further episodes of meningitis. Ultimately, nine o
f 10 patients survived with an average hospital stay of 27.8 days (med
ian of 17 days). The diagnosis of ICS requires a high index of suspici
on, imaging of the brain and paranasal sinuses, and aggressive interve
ntion.