2017 Sec 1 Green Book
A.
Garin
et al.
/ International
Journal
of Pediatric Otorhinolaryngology 79
(2015)
1752–1760
Table 2 Neurological
symptoms,
CRP
levels,
size
of
empyema,
surgical
treatment
and
outcomes
in
patients with
SE.
Patient initials
Neurological symptoms a
Initial CRP
Bacteria
First procedure
Second procedure
Third procedure
Residual
symptoms
Extension of
level
empyema
treatments
during
and the
1st
last
visit
(mg/ml)
before
surgery b
(follow-up
duration)
ONA hole
ONA
(Burr
(frontal
and motor
BD
FND DC S MS
Speech
72
Extended
Gram positive
cocci
drainage)
and parietal craniotomy)
difficulties (27 months),
AEDs
DC
S MS
6
Localized
NG
EEA
ONA
(frontal
Intermittent headaches (22 months) Concentration problems, EEG abnormalities, AEDs
and parietal craniotomy)
(parietal
EEA
ONA
ID
S
NA
Extended
Streptococcus constellatus
and
craniotomy) and FSO
species
Prevotella
(23 months)
(Burr
hole
difficulties,
LM MS S
124
Localized
EEA FSDext
ONA
Schooling
Streptococcus
drainage + puncture
headaches (29 months)
of
BA
under
frontal
guidance)
US
intermedius
(parietal
ONA
(frontal
difficulties,
Schooling
PLam S
NA
Localized
EEA
ONA
Fusobacterium
and
and
parietal
craniotomy)
medial
frontal
defect,
AEDs
parietal craniotomies) + FSO
bone
necrophorum
(20 months)
RM FND A S
and
ONA
(Frontal
(24 months)
AEDs
NA
Extended
EEA
Streptococcus constellatus
and parietal craniotomy)
FSDext
PLen
MS
86
Extended
NG
EEA
Headaches (27 months) problem (18 months) No
(frontal
TL
S ICHS
292
Extended
ONA
Streptococcus species
medial craniotomy)
VJ
None
35
Extended
EEA ONA,
No problem (33 months)
Fusobacterium necrophorum
(frontal
and
medial
parietal craniotomies), FSO
requiring more
than one procedure. Unshaded portion: Cases
successfully
treated with a
single operation. AEDs: antiepileptic drugs BA: brain abscess
Shaded portion: Cases
focal neurological deficit FSD:
frontal sinus drainage, either
DC: decreased consciousness EEA: endoscopic ethmoidectomy and antrostomy EEG: electroencephalogram FND:
through
an
external
(FSDext)
or
through
an
endoscopic Draf
type
III
approach
(FSDendos)
FSO:
frontal
sinus
obliteration
ICHS:
Intracranial
hypertension
syndrome MS:
syndrome NA:
not
available NG:
no
bacterium
isolated
in
bacteriological
samples ONA:
open
neurosurgical
approach
S:
seizure.
Meningeal
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 infected
lobe, next
to
the
infected
frontal and anterior ethmoid sinuses.
empyema
had
spread way
beyond
the
polar
or
basal
region
of
the
frontal
lobe
facing
the
sinus
(see
also
Figs.
1
and
4 ).
Extended
The
preoperative
CRP
levels
(mg/l)
(mean
SD)
were
not
cases
(17.5%)
(1
SE
and 2 EE).
There was no
clear
explanation
in
3
between
the
SE
(102
101)
and
EE
groups
(112
119).
the clinical charts concerning the choice of the
imaging
techniques.
different
did
the
CRP
levels
differ
between
patients
requiring
only
one
thickened
inflammatory mucosa,
possibly
associated with
Nor
A
127)
or
several
drainage
surgeries
(97
75).
the presence of pus, was observed in
the maxillary and ethmoidal
(114
Blood cultures were positive
in only one patient with SE and
in no
in
100%
of
cases,
in
the
frontal
sinus
in
88%
of
cases
sinuses
EE.
Perioperative
pus
samples were
positive
in
67%
( n = 15), and
in the sphenoid sinus
in 53% of cases ( n = 9). Fifty nine
patients with ( n = 6) of SE
(3 sinus samples and 3
intracranial samples) and
in 75%
cases of maxillary
and
ethmoidal
sinusitis,
and 59% of
percent of
( n = 6)
of
EE
(2
sinus
samples
and
4
intracranial
samples).
Lumbar
of
frontal
sinusitis were
bilateral.
Ethmoidal
inflammation
cases
in 4 patients with
SE due
to meningeal
concerned
the
interior
part
of
this
paranasal
sinus.
Two
punctures were performed
mostly
and
did
not
retrieve
any
bacteria.
In
cases
of
SE,
the
clearly
resulted
from
the
ethmoidal
sinus
since
these
syndrome
cases
bacteria
were
the
following:
did
not
have
any
frontal
sinus.
In
one
case,
the
EE
isolated
patients
Streptococcus
constellatus
( n = 2), Non-specified Streptococcus ( n = 2), Streptococcus intermedius ( n = 1), Fusobacteriumnecrophorum ( n = 1), Fusobacteriumnucleatum ( n = 1) and Provatella species ( n = 1). Bacteria isolated in children with EE were: S. intermedius ( n = 4), Staphylococcus lugdunensis ( n = 1) , Staphylococcus aureus ( n = 1), Staphylococcus capitis ( n = 1) and Propionobacterium acnes ( n = 1).
from a Pott’s puffy
tumor and not directly
from a
sinus
originated
cavity 1 , D1). In three cases (2SE and1 EE), the empyema and the infected sinus were not contiguous ( Fig. 2 ). An erosion of the posterior wall of the frontal sinus was observed in one case (EE) and an erosion of the ethmoidal roof in two cases (1 SE and 1 EE) ( Fig. 3 ). The locations and extensions of the empyema on the initial imaging and at the time of theirmaximal expansionare shown in Figs. 1 and4 , respectively. The locations of empyema were as follows: ( Fig.
Radiological
findings
3.3.
imaging
techniques
performed
before
the
first
surgical (6 SE and
The
the
following: CT scans
in 10 cases
(59%)
procedure were
For
SE,
the
frontal
polar
region
was
involved
in
89%
of
cases
in 4 cases
(23.5%)
(2 SE and 2 EE) and CT scan and MRI in
4 EE), MRI
( n = 8),
the
frontal basal
in one
case,
the parietal
region
in 78% of
85
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