[Endoscopic treatment of patients with intracranial complications of sinusitis].
BACKGROUND
Intracranial complications of sinusitis (cerebral, epidural, and subdural abscesses, meningitis, and dural sinus thrombophlebitis) remain a challenging and current topic. Although they are nowadays relatively rare, prompt recognition of these disease states is important to prevent permanent neurological deficit or fatality. Infection may spread hematogenously or by direct extension. Patients with complications require surgery to remove the focus of infection from the sinuses and drain the abscess. Recently, endoscopic frontal and sphenoid sinus surgery has emerged as the preferred technique for the treatment of the most advanced and complicated chronic sinusitis.


METHODS
Records of 7 patients aged from 13 to 65 (mean 30.6) years treated in our department for intracranial complications between January 2002 and September 2006 were analysed retrospectively. The diagnosis of meningitis was established in 2 patients, in one case with accompanying bilateral oculomotor nerve palsy. Cavernous sinus thrombosis, frontal abscess with hemiplegia, cerebral oedema, bilateral oculomotor nerve palsy and retrobulbar optic nerve neuritis with blindness was diagnosed each in one individual. 5 endoscopic bilateral frontosphenoethmoidectomies and 2 endoscopic sphenoethmoidectomies were performed. In one case a frontosphenoethmoidectomy was combined with craniotomy.


RESULTS
All preoperative symptoms subsided in 4 operated individuals. Vision improved in the patient with bilateral retrobulbar optic nerve neuritis. In patients with hemiplegia and bilateral oculomotor nerve palsy the symptoms persisted. No complications of the surgery were observed.


CONCLUSIONS
Surgical treatment of the focus of infection in the sinuses can be accomplished endoscopically via an intranasal approach with less morbidity, easy identification of anatomical structures, physiological drainage of the sinuses and superior cosmetic effects.
Katedra i Klinika Otolaryngologii, Collegium Medicum UJ w Krakowie.
Paweł
P
Strek
Olaf
O
Zagólski
Jacek
J
Składzień
Krzysztof
K
Oleś
Karolina
K
Hydzik-Sobocińska
Daniel
D
Najdzionek
Roman
R
Głowacki
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004724:Endoscopy / Q000379:methods; D020802:Epidural Abscess / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005334:Fever / Q000209:etiology; D015522:Frontal Sinusitis / Q000000981:diagnostic imaging / Q000601:surgery; D006261:Headache / Q000209:etiology; D006801:Humans; D008297:Male; D008581:Meningitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery*; D015524:Sphenoid Sinusitis / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome