Bandino F, Thota R, Pendolino AL, Chaidas K, Jeyaretna S, Lawrence T, Martinez-Devesa P, Qureishi A. A surgical protocol for sinogenic brain abscess: the Oxford experience and a review of the literature.
Rhinology 2022;
60:357-367. [PMID:
35726849 DOI:
10.4193/rhin22.070]
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Abstract
BACKGROUND
Rhinosinusitis-induced brain abscesses are rare but can result in devastating long-term sequalae and mortality; they require a high index of suspicion with early imaging to start early empiric parenteral antibiotic treatment covering aerobes and anaerobes.
METHODOLOGY
Our study was a retrospective analysis on 32 patients who were treated at Oxford University Hospitals for rhinosinusitis-induced brain abscess between February 2013 and June 2020.
RESULTS
Mean age of presentation was 45.83 for adults and 11.14 for children. Subdural collection was the most frequent abscess but 25% of patients had multiple sites of collection; the majority were in the frontal lobe. The most commonly identified pathogens were Streptococcus milleri group and Staphylococcus aureus; 93.75% of the patients were treated with combined Ceftriaxone and Metronidazole for an average of 8 weeks.
CONCLUSIONS
In our series most patients received also a prompt and aggressive surgical treatment with combined neurosurgical and ENT procedures in the majority; this was especially important in case of subdural empyema, Streptococcus milleri infection and direct intracranial spread of infection. More than half of the patients were treated with a single surgical procedure. Despite aggressive treatment, one third of patients experienced long-term neurological sequelae; there were no deaths.
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