108 / 232
cases
(
n
= 7),
and
the
interhemispheric
fissure
in
67%
of
cases
(
n
= 6).
For
EE,
the
frontal
polar
region was
involved
in
87.5%
of
cases
(
n
= 7),
the
frontal
basal
in
two
cases,
the
parietal
region
in
one
case
and
the
hemispheric
fissure
in
no
cases.
Cerebral,
venous,
orbital
and
other
lesions
associated with
the
empyema
are
detailed
in
Table
4
.
3.4.
Treatments
and
outcomes
All
patients
were
hospitalized
in
a
pediatric
neurosurgical
intensive
care
unit
and were
rapidly
treated with
the
following
drugs:
broad
spectrum
intravenous
antibiotherapy
active
on
the
bacteria
usually
involved
in
these
infections
and
with
a
good
diffusion within
the
bone,
epidural
and
subdural
spaces usually
encompassing 3rd generation cephalosporins and metronidazole
or
clindamycin
corticosteroids
in
the
presence
of
cerebral
edema
anticoagulant drugs
in
case of proven or highly
suspected
septic
thrombophlebitis
antiepileptic
drugs
if
necessary.
The
surgical
treatments
undergone
by
our
patients
are
described
in
Tables
2–5
.
Even
though
the
mean
numbers
of
surgeries was not different between
the SE
(1.8 operations/patient)
and
EE
(1.4
operations/patient)
groups
(
p
= 0.18),
the
number
of
patients
who
recovered
after
a
single
surgical
procedure
was
higher
in
the EE group
(
Table 5
;
p
= 0.06).
In both SE and EE groups,
the success rate of
the first surgical procedure was not significantly
influenced
by
the
surgical
approach
(ONA
or
ETA).
However,
in
Table
3
Neurological
symptoms,
CRP
levels,
size
of
empyema,
surgical
treatment
and
outcomes
in
patients with
EE.
Patient
initials
Neurological
symptoms
a
Initial
CRP
level
(mg/ml)
Size
of
the
empyema
before
1st
surgery
b
Bacteria
First
procedure
Second
procedure
Third
procedure
Residual
symptoms
and
treatments
during
the
last
visit
(follow-up)
CW S
74
Localized NG
Endoscopic
antrostomy
EEA
ONA
(technique
not
specified)
FSO
Slow
cognitive
procETAing,
abnormal
EEG,
AEDs
(11 months)
KK
None
207
Extended
Staphylococcus
lugdunensis
,
Staphylococcus
capitis
,
and
Propionobacterium
acnes
ONA
(frontal
craniotomy) + FSO
ONA
(frontal
craniotomy)
No
problem
(10 months)
MD
None
339
Localized
Staphylococcus
aureus
EEA
FSDendos
Endoscopic
transnasal drainage
of
the
empyema
AEDs maintained
in
spite
of
normalized
EEG
(11 months)
CM S
71
Localized
Streptococcus
intermedius
EEA
FSDendos
Endoscopic
transnasal drainage
of
the
empyema
AEDs
(4 months)
CTK
None
NA
Localized NG
EEA
No
problem
(4 months)
KMF
None
53
Extended
Streptococcus
intermedius
ONA
(frontal
craniotomy) + FSO
No
follow-up
NZM None
32
Localized
Streptococcus
intermedius
ONA
(frontal
craniotomy) + FSO
No
problem
(4 months)
TE
ICHS
c
6
Localized
Streptococcus
intermedius
EEA
ONA
(frontal
craniectomy + BA
needle
aspiration)
FSO
d
Unsightly
secondary
displacement
of
the
Palacos
1
cranioplasty
(12 months)
Shaded portion: Cases
requiring more
than one procedure. Unshaded portion: Cases
successfully
treated with a
single operation. AEDs: antiepileptic drugs BA: brain abscess
DC: decreased consciousness EEA: endoscopic ethmoidectomy and antrostomy EEG: electroencephalogram FND:
focal neurological deficit FSD:
frontal sinus drainage, either
through an external
(FSDext) or
through an endoscopic Draf
type
III approach
(FSDendos)
FSO:
frontal
sinus obliteration
ICHS:
Intracranial hypertension
syndrome NA: not
available NG:
no
bacterium
isolated
in
bacteriological
samples ONA:
open
neurosurgical
approach
S:
Seizure.
a
Headaches were
excluded
from
the
list
of
neurological
symptoms
as
it
could
have
also
resulted
from
sinusitis.
b
Localized empyema corresponded
to empyema
located
in
the
front of
the polar or basal part of
the
frontal
lobe, next
to
the
infected
frontal and anterior ethmoid sinuses.
Extended
empyema
had
spread way
beyond
the
polar
or
basal
region
of
the
frontal
lobe
facing
the
infected
sinus
(see
also
Figs.
1
and
4
).
c
This
intracranial
hypertension
syndrome with
headaches
and
vomiting was
probably mainly
due
to
the
presence
of
a
large
frontal
brain
abscess.
d
This
patient was
operated
on
4.5 months
after
the
initial
surgical
drainage
for
frontal
cranioplasty
using
polymethyl-methacrylate
(Palacos
1
).
Table
4
Lesions
associated with
the
SE
or
EE.
SE
(
n
= 9)
EE
(
n
= 8)
Pott’s
puffy
tumor
(
n
)
1
3
Brain
abscess
(
n
)
4
0
Septic
thrombophlebitis
of
the
superior
longitudinal
sinus
(
n
)
2
1
Orbital
abscesses
(
n
)
1
1
Other
lesions
or
disorders
Septic
pulmonary
embolism
(
n
= 1)
(
F.
necrophorum
)
Furunculosis
extended
over
the
abdominal
skin
and
4
limbs
one month
before
empyema
(
n
= 1)
(
S.
aureus
)
A.
Garin
et
al.
/
International
Journal
of
Pediatric Otorhinolaryngology
79
(2015)
1752–1760
86