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Pediatric
sinogenic
epidural
and
subdural
empyema:
The
role
of
endoscopic
sinus
surgery
A. Garin
a
,
B.
Thierry
a
, N.
Leboulanger
a
,
T.
Blauwblomme
b
, D. Grevent
c
,
S.
Blanot
d
,
N. Garabedian
a
,
V.
Couloigner
a
,
*
a
Pediatric
ENT Department, Hoˆpital Necker—Enfants Malades,
AP-HP, Universite´ Paris Descartes,
Paris,
France
b
Pediatric Neurosurgery Department, Hoˆpital Necker—Enfants Malades,
AP-HP, Universite´ Paris Descartes,
Paris,
France
c
Pediatric
Radiology Department, Hoˆpital Necker—Enfants Malades,
AP-HP, Universite´ Paris Descartes,
Paris,
France
d
Department
of
Anesthesiology, Hoˆpital Necker—Enfants Malades,
AP-HP, Universite´ Paris Descartes,
Paris,
France
1. Introduction
The
most
commonly
applied
definition
of
pediatric
acute
bacterial sinusitis
(PABS)
is an upper
respiratory
infection
in which
symptoms
are
not
improving
after
10–14
days
and
often
worsening
after
5–7 days
[1]
.
In
a
large Northern American
study
using
the
‘‘Nationwide
Emergency
Department
Sample
2008
database’’
and
including
101,660
children,
complications
were
documented
in
0.7%
of
children
presenting
to
emergency
departments with
the
diagnosis
of
PABS
[2]
.
Of
those
children
with
complications,
15%
had
periorbital
cellulitis,
76%
had
orbital
complications
and
9%
had
intracranial
complications.
Orbital
complications were
associated with
a
younger mean
age
(7.3
years
versus
11.9
years
for
intracranial
complications).
Smaller
retrospective
studies
detailed
the
distribution
of
subcategories
of
intracranial
complications.
In
a
cohort
of
104
International Journal of Pediatric Otorhinolaryngology 79 (2015) 1752–1760A
R
T
I
C
L
E
I
N
F
O
Article
history:
Received
31 May
2015
Received
in
revised
form
2
August
2015
Accepted
3
August
2015
Available
online
13 August
2015
Keywords:
Rhinosinusitis
Intracranial
complications
Abscess
Draf
III
procedure
A
B
S
T
R
A
C
T
Aim:
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.
Material
and 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. Main
outcome measures:
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).
Discussion:
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.
2015
Elsevier
Ireland
Ltd.
All
rights
reserved.
* Corresponding
author.
Tel.:
+33
1
44
49
46
82;
fax:
+00
33
1
44
49
46
90.
address:
vincent.couloigner@nck.aphp.fr(V.
Couloigner).
Contents
lists
available
at
ScienceDirectInternational
Journal
of
Pediatric Otorhinolaryngology
jour nal
homepage:
www.elsevier .com/locat e/ijpo r l http://dx.doi.org/10.1016/j.ijporl.2015.08.0070165-5876/
2015
Elsevier
Ireland
Ltd.
All
rights
reserved.
Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2015; 79(10):1752-1760.
83