title: Management and outcomes in children with sinogenic intracranial abscesses.
abstract: OBJECTIVE
  To report our experience of sinogenic intracranial abscesses in the paediatric population and to guide medical and surgical management.
  
  
  METHODS
  All children with sinogenic intracranial abscesses presenting to a large university teaching hospital over a five-year period were included in the study. Data on clinical presentation, radiological findings, microbiology, medical and surgical management and follow-up were recorded and analysed.
  
  
  RESULTS
  We identified 27 children aged 12.9 ± 3.4 years of which 56% were male. Fourteen (52%) children had extradural abscesses, nine (33%) subdural abscesses and four (15%) parenchymal abscesses. Early sinus drainage procedures were performed on 24 (89%) patients, and the same number required neurosurgical drainage. Streptococcus milleri was isolated in 18 (67%) cases. An initial conservative neurosurgical approach failed in 50% of cases where trialled, and was associated with longer length of stay (p = 0.025). In comparison to extradural abscesses, subdural abscesses were more likely to present with neurological deficits (p < 0.001) and reduced consciousness (p = 0.018), and required multiple neurosurgical procedures (p < 0.001), longer stays (p = 0.017), and had greater morbidity at six months (p = 0.017). A third of children had significant morbidity at six months, which included cognitive and behavioural problems (25%), residual hemiparesis (19%) and expressive dysphasia (7%). There were no mortalities.
  
  
  CONCLUSIONS
  Sinusitis complicated by intracranial abscess remains a contemporary problem. We demonstrate good outcomes with an early combined rhinological and neurosurgical approach. S. milleri is identified as the causative organism in the majority of cases, and empirical antimicrobial treatments should reflect this.
authors.affiliation: Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. Electronic address: anant.patel@doctors.org.uk.
authors.forename: Anant P
authors.initials: AP
authors.lastname: Patel
authors.affiliation: Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Liam
authors.initials: L
authors.lastname: Masterson
authors.affiliation: Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Deutsch
authors.affiliation: Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Scoffings
authors.affiliation: Department of ENT Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fish
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001039:Aphasia, Broca / Q000382:microbiology; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D002648:Child; D002653:Child Behavior Disorders / Q000382:microbiology; D003072:Cognition Disorders / Q000382:microbiology; D003244:Consciousness Disorders / Q000382:microbiology; D004322:Drainage; D013354:Empyema, Subdural / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D010291:Paresis / Q000382:microbiology; D012189:Retrospective Studies; D012852:Sinusitis / Q000150:complications* / Q000601:surgery; D014057:Tomography, X-Ray Computed
chemical_list: D000890:Anti-Infective Agents
keywords: Brain abscess; Complicated sinusitis; Intracranial abscess; Paediatric sinogenic abscess