2017 Sec 1 Green Book

Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2015; 79(10):1752-1760.

International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

1752–1760

Contents

lists

available

at ScienceDirect

International

Journal

of Pediatric Otorhinolaryngology

jour nal

homepage:

www.elsevier .com/locat e/ijpo r l

Pediatric

sinogenic

epidural surgery

and

subdural

empyema:

The

role

of

endoscopic

sinus

A. Garin a ,

Thierry a , N.

Leboulanger a ,

T. Blauwblomme b , D. Grevent c , S.

Blanot d ,

B.

N. Garabedian a ,

Couloigner a , *

V.

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, of Anesthesiology, Hoˆpital Necker—Enfants Malades,

AP-HP, Universite´ Paris Descartes, AP-HP, Universite´ Paris Descartes,

Paris,

France

d Department

Paris,

France

A

R

T

I

C

L

E

I

N

F

O

A

B

S

T

R

A

C

T

Article

history:

To analyze

the indications and outcomes of open neurosurgical approaches

(ONA) and endoscopic

Aim:

Received Received Accepted Available

31 May

2015

approaches

(ETA)

in

the

surgical management

of

pediatric

sinogenic

subdural

and

epidural

transnasal empyema. Material

in

revised August

form 2015

2

August

2015

3

Retrospective

single-center

study

design within

a

tertiary

care

referral

center

and methods:

online

13 August

2015

less than 18 years of age consecutively operated on between

January 2012 and February

setting. Children

for drainage of a

sinogenic subdural empyema

(SE) or epidural

(EE) empyema were

included. Main

2014

Keywords: Rhinosinusitis Intracranial

success of first

surgical procedure, persistent

symptoms

and

sequelae

at

the

end of

outcome measures:

follow-up

period.

the

complications

Nine SE

(53%) and 8 EE

(47%) were observed. Neurological

symptoms, especially

seizures, were

Results:

Abscess Draf III

frequent

in the SE group. Perioperative pus samples were positive

in 67% of

the SE group and

in 75%

more

procedure

the EE group. The most

frequently

isolated bacteria belonged to

the Streptococcus anginosus group. CT

of

imaging

showed

that most ethmoiditis

empyema

probably

originated

from

the

frontal

sinus. However,

two

or MR cases

resulted

from

an

and

one

case

from

a

Pott’s

puffy

tumor, without

any

direct

contact

the paranasal sinus.

In cases of SE,

the most effective surgical

technique was ONA with craniotomy.

with

sinus drainage was useful

for the purpose of bacteriological diagnosis.

In cases of procedure

Associated endoscopic

effectiveness was

noted

in

both

ONA

and

ETA

techniques.

In

two

cases

of

EE,

the

ETA

EE,

direct

drainage

of

the

empyema

through treated

the

posterior wall

of

the

frontal

sinus

(Draf

III in

encompassed

The

number

of

patients

successfully

after

a

single

surgical

procedure was

higher

approach).

EE

group

( p = 0.05).

Regarding

outcomes,

no mortalities were

observed.

Persistent

disorders

at

the

the end

of

the

follow-up

period,

especially

headaches,

cognitive,

concentration

or

schooling

problems,

to be more

frequent requiring

in

the SE group

than

in

the EE group

(67% vs 29%), and were more commonly

tended

in

cases

several

surgical

procedures

(75%

vs

12.5%)

( p = 0.05).

observed Discussion: sinogenic

Endoscopic

sinus

surgery

plays

a

critical

role

in

the

surgical

management

of

pediatric

SE

and

EE.

In

cases

of

small

volume

EE,

the

endoscopic

approach

associated

with

be

sufficient

to

treat

the

infectious

process. 2015

antibiotherapy may

Elsevier

Ireland

Ltd.

All

rights

reserved.

1. Introduction

the

‘‘Nationwide

Emergency

Department

Sample

2008 were

using

and

including

101,660

children,

complications

database’’

most

commonly

applied

definition

of

pediatric

acute

in

0.7%

of

children

presenting

to

emergency

documented

The

(PABS)

is an upper

respiratory

infection

in which

the

diagnosis

of

PABS

[2] .

Of

those

children

bacterial sinusitis

departments with

are

not

improving

after

10–14

days

and

often study

complications,

15%

had

periorbital

cellulitis,

76%

had

symptoms worsening

with

after

5–7 days

[1] .

In

a large Northern American

complications

and

9%

had

intracranial

complications.

orbital Orbital

complications were

associated with

a

younger mean

age

years

versus

11.9

years

for

intracranial

complications).

(7.3

retrospective

studies

detailed

the

distribution

of

Smaller

* Corresponding

author.

Tel.:

+33

1

44

49

46

82;

fax:

+00

33

1

44

49

46

90.

of

intracranial

complications.

In

a

cohort

of

104

subcategories

vincent.couloigner@nck.aphp.fr

(V.

Couloigner).

address:

E-mail

http://dx.doi.org/10.1016/j.ijporl.2015.08.007 0165-5876/ 2015 Elsevier Ireland Ltd. All

rights

reserved.

83