2017 Sec 1 Green Book

A.

Garin

et al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

1752–1760

Fig. 1. Cerebral

(*) or

( ^ ): Empyema

(D1 and D2). White arrows:

subcutaneous

abscess associated with Pott’s puffy

imaging performed

just before

the first

surgical procedure.

(D4). Black arrow: brain abscess. SE

initially operated by ETA alone 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

tumors

(C1–C4) was not smaller

than

those directly

treated with ONA remained distant

ETA

(D1–D4).

In

the

latter group,

the

that was successfully treated after ETA alone. EE

approach was

employed

in

the

case

of D1 because

the

ES

originated

from

a

Pott’s puffy

tumor

and

from

the

infected

sinuses,

in

case B2

external neurosurgical

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

as

an

initial

procedure

in

patient D3

is

unclear.

chosen

frequent

patients with

SE,

ONA

tended

to

be more

effective:

67%

(2/3)

of

symptoms

observed

were

headaches

and

cognitive,

who

recovered

after

a

single

surgical

procedure

were who

or

schooling

problems.

44%

of

patients

with

SE

children operated

concentration,

on

using

ONA

while

only

17%

(1/6)

of

children

and

43%

of

those with

EE

(3/7) were

still

being

treated with

(4/9)

requiring

several

surgeries were operated on using

drugs

during

their

latest

follow-up

visit.

recovered after

antiepileptic

( p = 0.22).

In

the

EE

group,

the

corresponding

percentages

ONA

4. Discussion

(3/6) and 50% in SE cases, 33%

(1/2),

respectively. Regarding

frontal

sinus

were 50% surgery, procedure

(1/3) of children who had a

single surgical operations had

and 33%

(2/6)

of

those who had

several

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

the

frontal sinus.

In

the EE group,

the

drainage or an obliteration of

percentages

were

50%

(3/6)

and

50%

(1/2),

corresponding

in both

SE

and EE

groups,

frontal

sinus

surgery

respectively. Thus,

not

improve

the

effectiveness

of

the

first

surgical

procedure. craniotomy

did

SE,

the most

effective

procedure was ONA with

In

2 )

( Table

During

the first

surgical procedure,

its

success

rate was 100%

(2/

14%

(1/7)

using

other

techniques

( p = 0.08).

2) versus

If we consider all surgical procedures,

its success rate was 88%

(7/

(25%)

(2/8)

using

other

techniques

( p = 0.04).

8) versus

No mortalities were observed in

the present

study. The

follow-

duration

was

longer

in

the

SE

group

( Table

5 ).

Persistent

up

and

disorders

at

the

end

of

the

follow-up

period

are the

symptoms

in Tables 2 and 3 . They

tended

to be more

frequent

in

detailed

group

than

in

the

EE

group

(67%

vs

29%)

( Table

5 ).

The most

SE

87