Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes | Adolescent Medicine | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Bradley  PJManning  KPShaw  MD Brain abscess secondary to paranasal sinusitis.  J Laryngol Otol 1984;98719- 725PubMedGoogle ScholarCrossref
Clayman  GLAdams  GLPaugh  DRKoopmann  CF  Jr Intracranial complications of paranasal sinusitis: a combined institutional review.  Laryngoscope 1991;101234- 239PubMedGoogle ScholarCrossref
Lerner  DNChoi  SSZalzal  GHJohnson  DL Intracranial complications of sinusitis in childhood.  Ann Otol Rhinol Laryngol 1995;104288- 293PubMedGoogle Scholar
Nielsen  H Cerebral abscess in children.  Neuropediatrics 1983;1476- 80PubMedGoogle ScholarCrossref
Singh  BVan Dellen  JRamjettan  SMaharaj  TJ Sinogenic intracranial complications.  J Laryngol Otol 1995;109945- 950PubMedGoogle Scholar
Maniglia  AJGoodwin  WJArnold  JEGanz  E Intracranial abscesses secondary to nasal, sinus, and orbital infections in adults and children.  Arch Otolaryngol Head Neck Surg 1989;1151424- 1429PubMedGoogle ScholarCrossref
Jones  RLViolaris  NSChavda  SVPahor  AL Intracranial complications of sinusitis: the need for aggressive management.  J Laryngol Otol 1995;1091061- 1062PubMedGoogle ScholarCrossref
Giannoni  CSulek  MFriedman  EM Intracranial complications of sinusitis: a pediatric series.  Am J Rhinol 1998;12173- 178PubMedGoogle ScholarCrossref
Gallagher  RMGross  CWPhillips  CD Suppurative intracranial complications of sinusitis.  Laryngoscope 1998;1081635- 1642PubMedGoogle ScholarCrossref
Jones  NSWalker  JLBassi  SJones  TPunt  J The intracranial complications of rhinosinusitis: can they be prevented?  Laryngoscope 2002;11259- 63PubMedGoogle ScholarCrossref
Heilpern  KLLorber  B Focal intracranial infections.  Infect Dis Clin North Am 1996;10879- 898PubMedGoogle ScholarCrossref
Remmler  DBoles  R Intracranial complications of frontal sinusitis.  Laryngoscope 1980;901814- 1824PubMedGoogle ScholarCrossref
Altman  KWAustin  MBTom  LWKnox  GW Complications of frontal sinusitis in adolescents: case presentations and treatment options.  Int J Pediatr Otorhinolaryngol 1997;419- 20PubMedGoogle ScholarCrossref
Bambakidis  NCCohen  AR Intracranial complications of frontal sinusitis in children: Pott's puffy tumor revisited.  Pediatr Neurosurg 2001;3582- 89PubMedGoogle ScholarCrossref
Heran  NSSteinbok  PCochrane  DD Conservative neurosurgical management of intracranial epidural abscesses in children.  Neurosurgery 2003;53893- 897PubMedGoogle ScholarCrossref
Herrmann  BWForsen  JW  Jr Simultaneous intracranial and orbital complications of acute rhinosinusitis in children.  Int J Pediatr Otorhinolaryngol 2004;68619- 625PubMedGoogle ScholarCrossref
Younis  RTAnand  VKDavidson  B The role of computed tomography and magnetic resonance imaging in patients with sinusitis with complications.  Laryngoscope 2002;112224- 229PubMedGoogle ScholarCrossref
Original Article
September 2006

Intracranial Complications of Sinusitis in Children and Adolescents and Their Outcomes

Author Affiliations

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

Arch Otolaryngol Head Neck Surg. 2006;132(9):969-976. doi:10.1001/archotol.132.9.969

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.