INTRACRANIAL COMPLICATIONS OF SINUSITIS - A PEDIATRIC SERIES

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.