2017 Sec 1 Green Book

A.

Garin

et

al.

/ International

Journal

of Pediatric Otorhinolaryngology 79

(2015)

1752–1760

Table 5 Treatments

and

outcomes.

SE

( n = 9)

EE

( n =8)

p

(months) a

< 10 6

25 23 22

5 9 7

7

4.5

Follow-up Duration

(days) a

of

hospital

stay

22 17

6 7

NS NS

(days) a

antibiotics

IV

of

initial

surgical

procedure

33% 17% 50%

(3/9) (1/6) (1/2)

75% 75% 67%

(6/8) (3/4) (2/3)

0.06

Success

( n = 6)

-ETA -ONA -ONA

( n = 2)

combined with

ETA

( n =1)

100%

(1/1)

100%

(1/1)

procedures a

number

of

surgical

1.8

0.7

1.4

0.7

0.18

Mean

(days) a

Hospitalization

duration

23

9

22

6

NS

surgical

procedures

All

(2/7) b

persistent

symptoms

at

the

end

of

the

follow-up

period

67%

(6/9)

29%

NS

Children with -Headaches

3 3 1 1 1 1

0 1 1 0 0 1

cognitive

or

schooling

problems

-Concentration,

EEG

-Abnormal

difficulties difficulties

-Speech -Motor

-Unsightly

cranial

vault

deformity

not

significant.

NS:

a Values

are

expressed

as means

SD.

b In

the

calculation of

the percentage of persistent

symptoms

at

the

end of

the

follow-up period

in

the EE group,

the denominator was

reduced

to 7

as one patient never

the

scheduled

follow-up

visits.

attended

or

the

probability

of

neurosurgical

intervention

and

long-term between

schooling problems,

tended

to be more

frequent

in

the

SE group

deficits

[9] .

Some

bacteriological

differences

in

the

EE

group

(67%

vs 29%). As

a

consequence

of

their more followed up

neurologic SE and EE

than

result

from

the more anaerobic environment of SE due to

uneventful postoperative course, children with EE were

p < 10 6 ).

reduced

connection

to

the

pneumatized

paranasal observed

sinuses.

a

shorter

period

of

time

( Table

5 ,

The

probability

of

its

for

staphylococci

are more

frequently

in

EE

and

symptoms was higher when

several

surgical procedures

Hence why

persistent

in SE

(present

study,

[4,5,9] ). This microbiolog-

( p = 0.05).

anaerobic bacteria

were needed

data

differs

from

those

observed

in

uncomplicated

PABS,

present

study

contains

some

limitations

and

drawbacks:

ical

The

pneumoniae ,

influenzae ,

and

where

Streptococcus

Haemophilus

are

isolated

in

about

30%,

30%,

and

10%

of

it it

is

a

single-center

and

retrospective

study

catarrhalis

Moraxella

respectively

[15] .

cases,

includes

a

small

number

of

patients,

even

if

it

represents

the

and

EE

always

require

hospitalization

in

a

pediatric

largest

published

series

of

pediatric

sinogenic

intracra-

SE

second

intensive

care

unit

and

the

rapid

institution indications

of

a

complications

[9]

neurosurgical

nial only

treatment.

With

regards

to

surgical

and

medical

children

who

underwent

surgery

for

SE

and

EE

were

our

data

strongly

suggests the most

that

they

considerably

that

empyema

cases which

did

not

require

modalities,

retrieved meaning

between

SE

and

EE.

In

SE,

effective

procedure

is

a

differ direct

not

included.

surgery were

and

large

drainage

through

a

craniotomy.

ETA

alone

is

not

in

the

present work,

out

of

7

patients with

SE

treated

advisable:

the 6 others required additional

this way, only one recovered while

5. Conclusions

( Fig. 1 , A3). As

shown

in

Fig. 1 ,

the poor

results

surgery with ONA

ETA

in

the

case

of

this

indication were

observed

even when

from

Intracranial

empyema

and

particularly

subdural

empyema

are

initial

extension

of

the

SE

was

very

limited.

However,

the

the

infections

that

require

a multimodal

approach,

involving

severe

of

ETA

to

ONA

was

useful

for

the

purpose

of

adjunction

ENT

surgeons,

radiologists

and

infectiologists.

neurosurgeons,

diagnosis

as

in

our

series

of

patients with

SE,

half

bacteriological

has

an

important

role

in

the management

of

intracranial

ETA

the

positive

bacteriological

samples

were

harvested

from

of

If

its

role may be

limited

to microbiological diagnosis in

empyema.

sinuses

during

the

ETA

procedure. and ONA

Hence,

we

recom-

paranasal

it

can

sometimes

successfully

treat EE,

especially when

the

EE

SE,

rapid

surgery

combining

ETA

in

pediatric

cases

of

mend

be

directly

drained

by

opening

of

the

posterior

wall

of

the

can

SE.

sinus

or

of

the

ethmoidal

roof.

frontal

as

shown by

the present data, more patients will

recover

In EE,

single

surgical procedure

than

in cases of SE. ETA may be an

after a

References

to ONA, especially when a direct drainage of

the EE can

alternative

[1]

M.J. Abzug, Acute

sinusitis S33–S37.

in

children:

do

antibiotics

have

any

role?

J.

Infect.

68

performed

through

a

Draf

III

approach

and

an

opening

of

the

be

1)

(2014)

(Suppl.

of

the

frontal

sinus.

In

some

instances

however,

a

posterior wall

A.R. ities

Sedaghat,

C.O. Wilke, M.J.

Cunningham,

S.L.

Ishman,

Socioeconomic

dispar-

[2]

endoscopic

drainage

is

impossible

due

to

the

location

and

direct

in

the

presentation

of

acute

bacterial

sinusitis

complications

in

children,

124

(2014)

1700–1706.

Laryngoscope L.E. Oxford,

of

the

EE,

or

due

to

the

presence

of

associated

lesions ( Fig. 1 ,

extensions

J. McClay,

Complications

of

acute

sinusitis

in

children, Otolaryngol.

[3]

( Fig. 1 , cases D1, D2 and D4). One of our cases

requiring ONA C2) and other

Surg.

133

(2005)

32–37.

Head Neck

literature data

[20] show

that

the presence of a Pott’s

D. Kombogiorgas,

R.

Seth,

R. Athwal,

J. Modha,

J.

Singh,

Suppurative experience

intracranial

[4]

tumor

does

not

contraindicate

an

exclusively

endoscopic

puffy

of

sinusitis

in

adolescence,

single

institute

and

review

complications

literature,

Br.

J. Neurosurg.

21

(2007)

603–609.

of

Finally,

the

drainage

or

obliteration

of

the

frontal

sinus

approach.

[5] N. Adame, G. Hedlund, C.L. Byington, Sinogenic

intracranial empyema

in children,

influence surgical outcomes

in patients with EE as well as in

did not

116

(2005)

e461–e467.

Pediatrics

SE. Regarding outcomes,

those with

M.

Calik,

A.

Iscan,

M.

Abuhandan,

I.

Yetkin,

F.

Bozkus¸

,

M.F.

Torun,

Masked

[6]

empyema

secondary

to

frontal

sinusitis,

Am.

J.

Emerg.

Med.

30

subdural

in accordance with

literature data

[3–6] , no

1657.e1–1657.e4.

(2012)

mortalities were the follow-up period, especially headaches and cognitive, concentration, observed. Persistent disorders at the end of

[7] P.K. Sharma, B. Saikia, R. Sharma, Orbitocranial

complications of acute

sinusitis

in

J.

Emerg. Med.

47

(2014)

282–285.

children,

90