Introduction
Acute bacterial rhinosinusitis is common in children and adolescents and
is frequently self-limiting. However, in a small proportion of patients
(3.9%) sinusitis can be complicated by intracranial abscesses namely
subdural empyema (SDE), intraparenchymal abscess (IPA) and extradural
abscess (EDA)[1]. The spread of infection occurs either via direct
extension (e.g. frontal bone osteomyelitis) or haematogenous
dissemination of bacterial pathogens from the paranasal sinuses[2].
Children may present with non-specific symptoms such as malaise,
headaches and fevers, which can result in a delay of correct diagnosis
and subsequently worse outcomes[3]. Previous studies have reported
significant morbidity with around half of patients requiring revision
surgery, a quarter experiencing neurological disability and a mortality
of 3-10%[4–6].
Optimal treatment of sinogenic intracranial suppuration in children is a
contentious issue. A number of studies have reported the results of
various treatment strategies; however, the evidence base is largely
restricted to small retrospective case series[7–11]. The majority
of the patients undergo either sinus drainage procedures or
neurosurgical interventions or the combination of the two[3]. In
addition, in a small proportion of patients a conservative medical
treatment has also been reported[12]. The question of how extensive
or aggressive the initial treatment strategy needs to be however remains
unanswered. While some studies advocate joint interventions addressing
both sinus and intracranial suppuration, others report that sinus
surgery alone alongside antibiotic therapy may be sufficient to avoid a
craniotomy[9,13,14]. However, due to the limited sample sizes and a
lack of direct comparisons between the treatment arms, it is currently
not clear which treatment strategies achieve the most favourable
outcomes.