2017 Sec 1 Green Book

A.

Garin

et

al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

1752–1760

Table 3 Neurological

symptoms,

CRP

levels,

size

of

empyema,

surgical

treatment

and

outcomes

in

patients with

EE.

Patient initials

Neurological symptoms a

Initial CRP

Size the empyema before 1st surgery b of

Bacteria

First

procedure

Second procedure

Third procedure

Residual

symptoms

level

treatments

during

and the

last visit (follow-up)

(mg/ml)

CW S

74

Localized NG

Endoscopic antrostomy

EEA

ONA (technique not

cognitive

Slow

abnormal

procETAing,

specified)

AEDs

(11 months)

EEG,

FSO

KK

None

207

Extended

ONA (frontal craniotomy) + FSO

ONA (frontal craniotomy)

No problem (10 months)

Staphylococcus lugdunensis , Staphylococcus capitis , and Propionobacterium acnes

MD

None

339

Localized

EEA FSDendos Endoscopic transnasal drainage of the empyema EEA FSDendos Endoscopic transnasal drainage of the empyema ONA (frontal craniotomy) + FSO (frontal craniotomy) + FSO (frontal craniectomy + BA needle aspiration) FSO d ONA EEA ONA EEA

in

AEDs maintained

Staphylococcus aureus

of

normalized

spite

(11 months)

EEG

AEDs

(4 months)

CM S

71

Localized

Streptococcus intermedius

CTK

None

NA

Localized NG

No problem (4 months)

No

None

53

Extended

follow-up

KMF

Streptococcus intermedius Streptococcus intermedius Streptococcus intermedius

No problem (4 months)

NZM None

32

Localized

ICHS c

6

Localized

Unsightly

secondary

TE

displacement the Palacos 1 cranioplasty (12 months) of

Shaded portion: Cases

requiring more

than one procedure. Unshaded portion: Cases

successfully

treated with a

single operation. AEDs: antiepileptic drugs BA: brain abscess

focal neurological deficit FSD:

frontal sinus drainage, either

DC: decreased consciousness EEA: endoscopic ethmoidectomy and antrostomy EEG: electroencephalogram FND:

(FSDext) or

through an endoscopic Draf

type

III approach

(FSDendos)

FSO:

frontal

sinus obliteration

ICHS:

Intracranial hypertension

syndrome NA: not

through an external

no

bacterium

isolated

in

bacteriological

samples ONA:

open

neurosurgical

approach

S:

Seizure.

available NG:

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 intracranial patient was

had

spread way

beyond

the

polar

or

basal

region

of

the

frontal

lobe

facing

the

sinus

(see

also

Figs.

1

and

4 ).

Extended

c This d This

hypertension

syndrome with

headaches

and

vomiting was

probably mainly

due

to

the

presence

of

a

large

frontal

brain

abscess.

(Palacos 1 ).

operated

on

4.5 months

after

the

initial

surgical

drainage

for

frontal

cranioplasty

using

polymethyl-methacrylate

cases

( n = 7),

and

the

interhemispheric

fissure

in

67%

of

cases

Treatments

and

outcomes

3.4.

( n = 6). For EE, ( n = 7),

the the

frontal frontal

polar basal

region was

involved

in

87.5%

of

cases

patients

were

hospitalized

in

a

pediatric

neurosurgical

All

in

two

cases,

the

parietal

region

in

one

care

unit

and were

rapidly

treated with

the

following

intensive

and

the

hemispheric

fissure

in

no

cases.

case

drugs:

venous,

orbital

and

other

lesions

associated with

the

Cerebral,

broad

spectrum

intravenous

antibiotherapy

active

on

the

are

detailed

in

Table

4 .

empyema

usually

involved

in

these

infections

and

with

a

good

bacteria

diffusion within 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 bone, epidural and subdural

Table 4 Lesions

associated with

the

SE

or

EE.

SE

( n = 9)

EE

( n = 8)

puffy

tumor

( n )

1 4 2

3 0 1

Pott’s Brain Septic

abscess

( n )

thrombophlebitis of the superior longitudinal sinus ( n )

surgical

treatments

undergone

by

our

patients

are

The

abscesses

( n )

1

1

Orbital

in

Tables

2–5 .

Even

though

the

mean

numbers

of

described

lesions

or

Septic pulmonary embolism ( n = 1) ( F.

Other

Furunculosis extended

the SE

(1.8 operations/patient)

surgeries was not different between

over

disorders

EE

(1.4

operations/patient)

groups

( p = 0.18),

the

number

of

and

abdominal

the

who

recovered

after

a

single

surgical

procedure

was

patients

skin

and

4

limbs

in

the EE group

( Table 5 ; p = 0.06).

In both SE and EE groups,

higher

necrophorum )

before

one month empyema

( n = 1)

the first surgical procedure was not significantly

the success rate of

aureus )

( S.

by

the

surgical

approach

(ONA

or

ETA).

However,

in

influenced

86