title: An unusual complication of epistaxis: cerebral abscess formation after anterior ethmoidal artery ligation.
abstract: Epistaxis is a very common emergency in otorhinolaryngology. Anterior ethmoidal artery ligation using an external approach is one of the surgical options in posterior epistaxis. We present, to the best of our knowledge, the first reported case of an intracerebral abscess after epistaxis treatment with ligation of the anterior ethmoidal artery using an endoscopic-assisted external approach in a 56-year-old patient. The patient presented 4 days postoperatively with an orbital cellulitis. A CT was performed and a frontobasal hypodensity was found. An additional MR tomography the next day showed a lesion suspicious for an intracerebral abscess. Despite intravenous antibiotic therapy, the lesion increased and was successfully treated by the neurosurgeons, with abscess resection over a craniotomy and frontobasal repair using a pedicled periosteal flap. Surgeons have to be aware of this rare but possibly lethal severe complication and should consider early imaging studies, especially if a periorbital cellulitis appears.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Kantonsspital Luzern, Luzern, Switzerland.
authors.forename: Karin
authors.initials: K
authors.lastname: Murer
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Holzmann
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Michael Benjamin
authors.initials: MB
authors.lastname: Soyka
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001158:Arteries / Q000601:surgery*; D001922:Brain Abscess / Q000188:drug therapy / Q000209:etiology*; D004359:Drug Therapy, Combination; D004844:Epistaxis / Q000601:surgery*; D005005:Ethmoid Sinus / Q000098:blood supply*; D006801:Humans; D008026:Ligation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D014786:Vision Disorders / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents