Single stage, transmastoid approach for otogenic intracranial abscess.
OBJECTIVE
To evaluate the treatment of intracranial abscess of otogenic origin, and to study the outcome measures of single stage treatment of the otogenic focus and drainage of intracranial abscess via a transmastoid approach.


METHODS
Retrospective case review.


METHODS
Dr Balabhai Nanavati Hospital and Medical Research Centre, Mumbai, India, an academic tertiary referral centre, and Shri H Bhagwati Municipal General Hospital, Mumbai, India, an academic secondary referral centre.


METHODS
Seventy-three patients with intracranial abscess secondary to otogenic pathology, confirmed by computed tomographic scanning.


METHODS
Single stage treatment of the ear pathology and drainage of intracranial abscess via a transmastoid approach, performed by the senior author (KPM).


RESULTS
Of the 73 patients, 12 were lost to follow up and were excluded from the study. Outcomes for the remaining 61 patients were known, and these patients were followed up for at least two years. Adults were more commonly affected by otogenic intracranial abscess than children, with a male preponderance. Otogenic intracranial abscess was associated with both cholesteatomatous (41 per cent) and non-cholesteatomatous ears (59 per cent). All cases were treated with transmastoid drainage of the intracranial abscess and canal wall up or down tympanomastoidectomy, depending on the ear pathology. Two cases developed post-operative cerebrospinal fluid leakage (3 per cent), and another two cases developed meningitis (3 per cent). Five patients had recurrent abscess; two of these patients (3 per cent) died but were included in the study. Three patients had residual abscess, improved with additional management.


CONCLUSIONS
In this series, the low morbidity and mortality rate, combined with a shorter hospital stay, suggest that single stage, transmastoid drainage of intracranial abscess and concurrent treatment of the otogenic pathology is an effective treatment for otogenic intracranial abscess.
Morwani
K P
KP
Shri H Bhagwati Municipal General Hospital, Mumbai, India.
Jayashankar
N
N
D000293:Adolescent; D000328:Adult; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008416:Mastoid / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult