title: Pediatric sinogenic epidural and subdural empyema: The role of endoscopic sinus surgery.
abstract: OBJECTIVE
  To analyze the indications and outcomes of open neurosurgical approaches (ONA) and endoscopic transnasal approaches (ETA) in the surgical management of pediatric sinogenic subdural and epidural empyema.
  
  
  METHODS
  Retrospective single-center study design within a tertiary care referral center setting. Children less than 18 years of age consecutively operated on between January 2012 and February 2014 for drainage of a sinogenic subdural empyema (SE) or epidural (EE) empyema were included.
  
  
  METHODS
  success of first surgical procedure, persistent symptoms and sequelae at the end of the follow-up period.
  
  
  RESULTS
  Nine SE (53%) and 8 EE (47%) were observed. Neurological symptoms, especially seizures, were more frequent in the SE group. Perioperative pus samples were positive in 67% of the SE group and in 75% of the EE group. The most frequently isolated bacteria belonged to the Streptococcus anginosus group. CT or MR imaging showed that most empyema probably originated from the frontal sinus. However, two cases resulted from an ethmoiditis and one case from a Pott's puffy tumor, without any direct contact with the paranasal sinus. In cases of SE, the most effective surgical technique was ONA with craniotomy. Associated endoscopic sinus drainage was useful for the purpose of bacteriological diagnosis. In cases of EE, effectiveness was noted in both ONA and ETA techniques. In two cases of EE, the ETA procedure encompassed direct drainage of the empyema through the posterior wall of the frontal sinus (Draf III approach). The number of patients successfully treated after a single surgical procedure was higher in the EE group (p=0.05). Regarding outcomes, no mortalities were observed. Persistent disorders at the end of the follow-up period, especially headaches, cognitive, concentration or schooling problems, tended to be more frequent in the SE group than in the EE group (67% vs 29%), and were more commonly observed in cases requiring several surgical procedures (75% vs 12.5%) (p=0.05).
  
  
  CONCLUSIONS
  Endoscopic sinus surgery plays a critical role in the surgical management of pediatric sinogenic SE and EE. In cases of small volume EE, the endoscopic approach associated with antibiotherapy may be sufficient to treat the infectious process.
authors: Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
authors: A
authors: A
authors: Garin
authors: Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
authors: B
authors: B
authors: Thierry
authors: Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
authors: N
authors: N
authors: Leboulanger
authors: Pediatric Neurosurgery Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
authors: T
authors: T
authors: Blauwblomme
authors: Pediatric Radiology Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
authors: D
authors: D
authors: Grevent
authors: Department of Anesthesiology, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
authors: S
authors: S
authors: Blanot
authors: Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
authors: N
authors: N
authors: Garabedian
authors: Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France. Electronic address: vincent.couloigner@nck.aphp.fr.
authors: V
authors: V
authors: Couloigner
mesh_terms: D000293:Adolescent; D002648:Child; D003072:Cognition Disorders / Q000209:etiology; D003399:Craniotomy / Q000009:adverse effects; D004322:Drainage; D013354:Empyema, Subdural / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D020802:Epidural Abscess / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D015521:Ethmoid Sinusitis / Q000000981:diagnostic imaging / Q000382:microbiology; D005260:Female; D015522:Frontal Sinusitis / Q000000981:diagnostic imaging / Q000382:microbiology; D006261:Headache / Q000209:etiology; D006801:Humans; D007859:Learning Disabilities / Q000209:etiology; D008297:Male; D009666:Nose; D011859:Radiography; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000150:complications*; D034366:Streptococcus anginosus
keywords: Abscess; Draf III procedure; Intracranial complications; Rhinosinusitis