2017 Sec 1 Green Book

A.

Garin

et

al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

1752–1760

children including

with

complicated

ABS,

14

intracranial

complications

2.4.

Review

of medical

records

2

brain

abscesses,

7

epidural pediatric sinusitis,

and

6

subdural

empyema

retrieved

[3] .

In

another

series

of

11

suppurative

charts were

retrieved

using

the

institutional

database

were

Clinical

intracranial abscesses (ICA), 3 SE, 2 EE, 2 SE associatedwith EE, and 1 SE associatedwith ICA were observed [4] . This data suggests that EE and SE represent the most frequent intracranial complications of pediatric ABS. However, only a few publications have specifically focused on their manage- ment, especially concerning the respective roles of ONA and ETA [3–9] . The primary objective of the present study was to compare the outcomes of ONA and ETA in a retrospective pediatric cohort of sinogenic empyema, in order to optimize the indications of surgical treatments of these complications. A secondary end point was to describe the clinical, bacteriological and imaging characteristics of pediatric cases of sinogenic SE and EE. complications of 3 intracranial

(Classification Commune des Actes Me´ dicaux). The medical

CCAM

of

children with

SE

or

EE were

reviewed

for

age,

gender,

records

conditions symptoms

before

diagnosis,

presenting

symptoms,

underlying

of

before

admission,

CRP

(C-reactive

protein)

duration

bacteriological

data,

CT

and MR

imaging

findings, medical

levels,

surgical

treatments

and

final

clinical

outcomes.

and

Data

analysis

2.5.

variables

were

described

using

their

mean

or

Quantitative

value

and

standard numbers

deviation,

and

qualitative

variables compar-

median

described

as

and

percentages.

Statistical

were isons

were

performed quantitative

using

Student’s

t -test

or

Mann–Whitney

test

for

variables

and

Chi-square

or

Fisher’s

exact

U

and methods

2. Material

for

qualitative

variables.

values

0.05

were

considered

test

P

significant.

statistically

manuscript

was

prepared

in

accordance

with

STROBE

The

[10] .

guidelines

3. Results

Study

design

2.1.

cases of

SE or EE operated

at our

institution

Out of 23 pediatric

the

study

period,

6 were

discarded

because

of

their

non-

during

single-center

retrospective

study

included

all

consecutive

This

(5 otogenic and 1 post-traumatic empyema). Nine

sinogenic origin

cases

of

epidural

or

subdural

empyema

operated

in

the

pediatric

(53%)

and

8

EE

(47%)

cases

were

finally

included.

Patients’

SE

and

ENT Departments

of Necker Hospital

Pediatric Neurosurgical

and

symptoms

are

described

in

Tables

1–3 .

The

demographics

January

2012

and

February

2014.

between

age was

11

years

(8.8–13.5)

in

the

SE

group

and not

10

years

median

in

the

EE

group

(NS).

The

sex

ratio was

different

(9.0–10.8) between

Inclusion

criteria

2.2.

both

groups

( Table

1 ).

of

sinogenic

subdural

or

epidural

empyema was

The diagnosis

Clinical

features

on

admission

and

before

surgery

3.1.

on

the

association

of

the

following

findings:

(i) an

clinical

or

based

signs

of

infection,

(ii)

the

observation

of

empyema

biological

features between

are

presented

in

Tables

1–3 .

The

major

Clinical

located

in

the

frontal

lobe, and of an opacity of

the

mainly or solely

both

groups number

was

the

neurological

clinical

difference

frontal

sinus on CT and MR

imaging,

(iii)

the absence

ethmoidal or

Indeed,

the

of

neurological

symptoms

per

presentation.

recent

cranial

trauma

or

surgery,

and

the

absence

of

any

other

of

(mean

SD) was

1.8

1.2

in

the

SE

group

and

0.4

0.5

in

patient

(tooth, middle

ear.) which

could

have

been

responsible symptoms

infection

EE

group

( p = 0.01).

The most

frequent

neurological

symptoms

the

the

empyema.

Neither

the

presence

of

clinical

for

seizures

(6

children

with

SE

and

2

with

EE)

and meningeal

were

with

sinusitis

(fever,

headache,

facial

subcutaneous

compatible swelling) empyema diagnosis

(4 patients with SE and none of

those with EE). Among

the

syndrome

nor

the

contiguity

between

the

sinus

opacity

and

the the

seizures, one patient had a

frontal

subdural

two patients with EE and

on

imaging

were

judged

necessary

to

make

( Table 2 ), possibly explaining

the cortical

irritation

leading

to

aeroma

of

sinogenic

empyema.

Indeed,

concerning

the

latter

seizure. Pott’s puffy

tumors

tended

to be more

frequent

in

the EE

the

the sinus opacity and

the

resulting empyema can sometimes

point,

(37.5%

vs

11%)

(NS)

( Table

4 ).

group

separated

from

each

other

due

to

one

of

the

following

be

mechanisms:

3.2.

CRP

levels

and

bacteriological

findings

Indirect spread of

infection between the sinus and the epidural or

levels

and

bacteriological

data

are

presented

in

Tables

2

CRP

space veins

through

the mucosal

veins

of

the

sinus

to

the

subdural emissary [11,12] or,

3 .

and

that

link

the

facial

and

dural

venous

systems frontal

in

cases of EE,

through an osteomyelitis of

the

Table 1 Patient

(Pott’s

puffy

tumor)

bone

clinical

characteristics.

Antibiotic

treatment prior

to brain

imaging: often, at

the

time of

SE

( n = 9)

EE

( n = 8)

empyema,

the

sinusitis has

already been diagnosed

diagnosis of

treated

for

several days with antibiotics. This

treatment

can

and

(years)

(median

SD)

11

3

10

4

Age Sex

ratio

(males/females)

4/5

5/3

the

extension

of

the

sinus

infection

and

induce

a

modify

( n )

3 1 4 1 1 4 2 6 1

5 2 2 0 0 0 0 2 1

Fever

between

the

sinus

opacity

and

the

empyema

on

separation

edema

( n )

Palpebral Headaches Neurological

imaging.

( n ) a

symptoms

findings

( n )

-Aphasia -Altered

Exclusion

criteria

2.3.

consciousness

syndrome

-Meningeal

exclusion

criteria were

the

following:

The

-Focal

neurological

deficit

-Seizure

Non-sinogenic

empyema.

hypertension

-Intracranial

Patients

older

than

18

years.

a Headaches were

excluded

from

the

list

of

neurological

symptoms

as

it

could

Insufficient

clinical,

biological

or

imaging

data.

have

also

resulted

from

sinusitis.

84