Sinogenic Intracranial Abscesses in Children - a Ten Year Experience

Abstract

Objective: To analyze the clinical course, management and outcomes of sinogenic intracranial abscesses in children over a ten-year period at a tertiary university hospital. Study Design: Retrospective cohort. Setting: Branch of Pediatric Otorhinolaryngology of a tertiary academic hospital center with Pediatric Neurosurgery and Pediatric Intensive Care facilities. Methods: Electronic charts of 14 pediatric patients below 18 years of age admitted with intracranial abscesses of sinogenic origin between January 2015 and December 2024 were retrospectively reviewed. Demographics, clinical presentation, laboratory findings, radiological results, microbiology, surgical and medical management, and outcomes were analyzed. Results: Males predominated (64.3%) with a mean age of 12.14 years. All patients presented with fever, and the majority had headache (92.9%) and neurological symptoms (57.1%). The frontal sinus was involved in all cases and subdural abscesses represented the most common intracranial complication. Streptococcus anginosus group was identified in 71.4% of positive cultures. All patients underwent broad-spectrum antibiotics and surgical intervention, with an average of 1.8 surgeries per child. Mean length of hospitalization was 53.2 days. No mortality or significant long-term morbidity occurred in any patient. Conclusion: Sinogenic intracranial abscesses affect predominantly adolescent males and frequently involve the frontal sinus. Streptococcus anginosus group strains were the predominant pathogen harvested in our series. Despite their high clinical severity, favorable outcomes with no long-term sequelae can be achieved if early recognition, aggressive surgical management and appropriate antimicrobial therapy are provided. Careful monitoring of adolescents with acute rhinosinusitis is warranted for early detection of intracranial complications.