Intracranial complications of acute rhinosinusitis in pediatric age: the role of endoscopic sinus surgery

Introduction: Intracranial suppurative infections are rare complications of acute rhinosinusitis. However, these remain challenging, as they carry a life-threatening potential and can become a source of disabling neurological sequelae. Objectives: Descriptive analysis as clinical presentation, analytical and radiological features, risk and prognostic factors, morbidity and mortality. Material and Methods: A group of 10 patients, with acute rhinosinusitis complicated with intracranial suppurative infections, admitted between January 2008 and December 2015, in a tertiary hospital, was retrospectively reviewed. Results: Mean age was 11.7 years and most patients were male (90%). Eight patients presented with fever at admission when, the most frequent neurologic symptom was headache (90%). More particular neurologic signs were hemiparesis (n=3), seizures (n=3), somnolence (n=4), neck stiffness (n=3) and ocular saccades (n=1). A single patient developed a unilateral VI cranial nerve paresis. The most common intracranial complications observed were epidural (n=4) and sudural empyema (n=4), followed by thrombosis of the superior sagittal sinus (n=2). None intracerebral abscesses was observed. Only patients with subdural empyemas presented with hemiparesis and episodes of seizures. All were administered broad-spectrum antibiotics. Eight patients were submitted to endoscopic sinus surgery, five to neurosurgical drainage and two to surgical treatment by ophthalmology. Mean time to first surgical intervention from admission was 1.38 days. Surgical revision was needed in four patients. Two patients still presented neurologic sequelae 6 months after discharge: one with encopresis and a second with distal paresis of the right lower limb. No permanent neurologic sequelae and deaths were observed. Conclusion: More specific neurologic signs, such as hemiparesis and seizures, seem to be associated to intra-axial complications, such as subdural empyema. However, the prognostic value of these signs is not clear, at least in a long-term point of view.  A prompt and adequate intervention may result in better outcomes by limiting mortality as well as decreasing the rate of neurologic sequelae.