Intracranial Complications of Pediatric Sinusitis

Abstract

OBJECTIVE: To study intracranial extension of pediatric sinusitis, an infrequent but potentially fatal complication. STUDY DESIGN AND SETTING: Ten-year retrospective review at a tertiary children's hospital identified 21 cases of intracranial complications of sinusitis. RESULTS: Thirteen males and eight females with mean age of 13.3 years were identified. Overall 18 of 21 (81%) exhibited abscess formation, most commonly epidural. Only 3 of 21 (14%) had meningitis alone. All but 4 patients were managed surgically, requiring craniotomy in 13 of 21 (61.9%) and endoscopic sinus surgery (ESS) in 10 of 21 (48%). Seven patients (33%) required multiple operations during admission. Nineteen patients (90%) had a total of 30 organisms cultured. Oral flora was observed in 12 of 21 (57%). Polymicrobial infections, seen in 9 of 21 (43%), were significantly associated with the need for craniotomy ( P = 0.02). Mean hospital stay was 15 days, and mean length of IV antibiotic was 5 weeks. CONCLUSIONS: Intracranial complications of pediatric sinusitis often require craniotomy. Oral flora and polymicrobial infections were prominent in this series. EBM rating: C-4