109 / 232
patients with
SE,
ONA
tended
to
be more
effective:
67%
(2/3)
of
children
who
recovered
after
a
single
surgical
procedure
were
operated
on
using
ONA
while
only
17%
(1/6)
of
children
who
recovered after
requiring
several
surgeries were operated on using
ONA
(
p
= 0.22).
In
the
EE
group,
the
corresponding
percentages
were 50%
(3/6) and 50%
(1/2),
respectively. Regarding
frontal
sinus
surgery,
in SE cases, 33%
(1/3) of children who had a
single surgical
procedure
and 33%
(2/6)
of
those who had
several
operations had
drainage or an obliteration of
the
frontal sinus.
In
the EE group,
the
corresponding
percentages
were
50%
(3/6)
and
50%
(1/2),
respectively. Thus,
in both
SE
and EE
groups,
frontal
sinus
surgery
did
not
improve
the
effectiveness
of
the
first
surgical
procedure.
In
SE,
the most
effective
procedure was ONA with
craniotomy
(
Table
2
)
During
the first
surgical procedure,
its
success
rate was 100%
(2/
2) versus
14%
(1/7)
using
other
techniques
(
p
= 0.08).
If we consider all surgical procedures,
its success rate was 88%
(7/
8) versus
(25%)
(2/8)
using
other
techniques
(
p
= 0.04).
No mortalities were observed
in
the present
study. The
follow-
up
duration
was
longer
in
the
SE
group
(
Table
5
).
Persistent
symptoms
and
disorders
at
the
end
of
the
follow-up
period
are
detailed
in
Tables 2 and 3
. They
tended
to be more
frequent
in
the
SE
group
than
in
the
EE
group
(67%
vs
29%)
(
Table
5
).
The most
frequent
symptoms
observed
were
headaches
and
cognitive,
concentration,
or
schooling
problems.
44%
of
patients
with
SE
(4/9)
and
43%
of
those with
EE
(3/7) were
still
being
treated with
antiepileptic
drugs
during
their
latest
follow-up
visit.
4. Discussion
The
clinical expressions of SE and EE are dramatically different.
Subdural
empyema
often
presents
itself
in
neurosurgical
emer-
gencies whereas epidural empyema
is often diagnosed on
imaging
studies.
Therefore,
the
place
of
the
ENT
surgeon
may
differ
according
to
the
localization
of
the
empyema.
The
aim
of
the
present
study
was
to
describe
the
clinical
characteristics of pediatric sinogenic EE and SE, and
to discuss
their
optimal
treatment
strategies.
Since most cases of empyema were associated with an
infection
of both
the
ethmoidal
and
frontal
sinuses,
it was often
impossible
to
determine with
certainty
from which
sinus
the
SE
or
EE
had
developed
from. The observation of an erosion of
the posterior wall
of
the
frontal
sinus or
the
superior wall of
the ethmoidal
sinus was
rarely
contributive
in
the
determination
of
ethmoidal
or
frontal
sinus
involvement as
it was present
in only
three cases
(
Fig. 3
). The
presence
of
Pott’s
puffy
tumors
in
4
patients
did
not
allow
the
ruling
out
of
an
ethmoidal
origin
as
osteomyelitis
of
the
frontal
bone
can
result
from
ethmoiditis
[13]
.
However,
two
arguments
Fig. 1.
Cerebral
imaging performed
just before
the first
surgical procedure.
(*) or
(
^
): Empyema
(D1 and D2). White arrows:
subcutaneous
abscess associated with Pott’s puffy
tumors
(D4). Black arrow: brain abscess. SE
initially operated by ETA alone
(A1–A7) was smaller
than
those
initially
treated by ONA
ETA
(B1–B3).
(A3) was
the only case of SE
that was successfully treated after ETA alone. EE
initially operated by ETA alone
(C1–C4) was not smaller
than
those directly
treated with ONA
ETA
(D1–D4).
In
the
latter group,
the
external neurosurgical
approach was
employed
in
the
case
of D1 because
the
ES
originated
from
a
Pott’s puffy
tumor
and
remained distant
from
the
infected
sinuses,
in
case B2
because of
the size and extensions of
the empyema, and
in case D4 because of
the presence of a
large brain abscess
requiring direct neurosurgical drainage. The reason why ONA was
chosen
as
an
initial
procedure
in
patient D3
is
unclear.
A.
Garin
et al.
/
International
Journal
of
Pediatric Otorhinolaryngology
79
(2015)
1752–1760
87