JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
PATTERN OF INTRACRANIAL COMPLICATIONS OF SINUSITIS IN KOMFO ANOKYE TEACHING HOSPITAL
*J. Opoku-Buabeng1, Owusu B2. 1
Department of Ear, Nose and Throat (ENT), 2Neurosurgery Unit
KomfoAnokye Teaching Hospital, Kumasi, Ghana. E-Mail: [email protected] *Correspondence Grant support: None Conflict of Interest:
None
ABSTRACT Background:Patients with intracranial complications of sinusitis present a major challenge to all, physicians, otorhinolaryngologists and neurosurgeons, because the purulent collection can be in areas that are not easily accessible like the interhemispheric and subfrontal areas of the brain and continue to exert toxic effects that account for the morbidity and mortality associated. Aims and Objectives:To determine the incidence, symptoms, pattern, the management and the outcome of intracranial complications of sinusitis in KomfoAnokye Teaching Hospital, Kumasi, Ghana. Study Design: It was a prospective study of 39 patients who presented with intracranial complicationsof sinusitis. Setting: The study was carried out in KomfoAnokye Teaching Hospital (KATH), in Kumasi, Ghana.
10
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Patients and Methods: Patients who reported to KATH with sinugenic intracranial complications from January 2007 to December 2011 were prospectively studied using a standard proforma to record details of their demographic, clinical presentations, management data and outcome. Results: The incidence rate of sinugenic intracranial complications was 3.2%. They consisted of 69.2% males and 30.8% females, with a male-to-female ratio of 2.3: 1 and a mean age of 25.3 years. The most common symptoms were headache in 100%, fever in 92.3%, nausea / vomiting in 30.8%, sinus tenderness in 10.3%, hemiparesis in 2.6%, proptosis in 12.8% and lethargy in 5.1% of the cases. Epidural abscess was the commonest sinugenic intracranial complication in 35.9%, sudural abscess in 25.6%, meningitis in 20.5%, cavernous sinus thrombosis in 12.8% and cerebral abscess in 5.2%. Sinus surgeries were performed in 71.8% and neurosurgical operations were also performed in 66.7% of the cases. Single modality treatment of sinus surgery was performed in 33.3% of the cases, neurosurgical procedure in 28.2% whereas a combined treatment was performed in 38.5%. The management outcomes were successful in 87.7% and unsuccessful in 2.6%. Conclusion:Even though the incidence rate of sinugenic intracranial complications was minimal as compared to some literatures, they still require a prompt and a collaborative management of the physician, otorhinolaryngologist and the neurosurgeon. Key words: Sinugenic intracranial complications, Epidural abscess, Headache, Sinus surgery, Neurosurgical operation.
INTRODUCTION Intracranial complications of sinusitis remain a challenge and contemporary topic of medical and surgical emergency. The anatomical relationship between the paranasal sinuses and the brain make it easy for sinusitis to spread and produce intracranial complications. Hicks et al reported an incidence rate of 3.9% in a retrospective study in children [1]. Giannoni et al reviewed 212 patients with intracranial suppurative infection and found out that sinugenic infection was identified in 12 (5.7%) [2].
11
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Hicks et al identified the symptoms of intracranial complications to be headache (92.0%), fever (85%), nausea/vomiting (62.0%) sinus tenderness (31.0%) and lethargy (23.0%). Jones et al reported in Birmingham (UK) of 12 cases consisting of 9 males and 3 females, aged (16-74) years (mean age of 35.5 years). They stressed the importance of the combined management by the otorhinolaryngologist and the neurosurgeon. In their study 9 of the patients underwent sinus surgery of which 3 had frontal trephination, 4 had frontoethmoidectomy and 2 underwent sphenoid drainage. Besides these same patients underwent neurosurgical procedures of which 7 had craniotomy and 3 had Burr-hole drainage [3]. Sable et al reported an incidence rate of (20-40 %) [4]. Younis et al reported 82 patients admitted in University of Mississippi Medical Centre between January 1, 1985 and December 31, 1999 for treatment of complications of sinusitis. They found that 39 patients had intracranial complications;53.8% had meningitis, 15.4% had epidural abscess, 12.8% had subdural abscess, 10.3% had intracerebral abscess, whereas Pott’s puffy tumour and cavernous sinus thrombosis was found in 2.6% each of the cases [5]. Kombogiorgas et al reported in a study in which they investigated the outcome of neurosurgical treated children with sinusitis induced complications (SIC) retrospectively. Of the 11 patients studied upon, 10 were males whereas 1 was a female. The patients presented with the following symptoms, headache (81.8%), vomiting (45.5) % swelling of the forehead (45.5%). These patients were managed with sinus surgery of which 8 underwent frontal trephination, whereas neurosurgically 8 underwent Burr-hole drainage. Theyidentified 2 cases with epilepsy as an outcome after the management [6]. Venketesh et al also reported in Bengalore, India of 14 patients consisting of 9 males and 5 females of which craniotomy were performed in 79% whereas Burr-hole drainage in 21%. They reported no sequelae in their management [7].
PATIENTS AND METHOD This was a 5-year prospective study conducted at the Ear, Nose and Throat (ENT) clinic and the Neurosurgical unit of the KomfoAnokye Teaching Hospital (KATH) Kumasi, Ghana between January 2007 and December 2011.
12
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
This facility is the second largest teaching hospital in the country and it provides services to most people from the middle belt and the northern part of the country. These were patients who were diagnosed as cases of sinugenic intracranial lesions, having undergone ENT examinations, neurological clinical examinations and having taken a computerized tomography imaging of the head and neck as shown in Figures 1 and 2. The patients were admitted to the wards, managed with intravenous antibiotics, analgesic/antipyretics and steroid. Some of the patients underwent neurosurgical and sinus surgeries as shown in Figure 3. Consents were obtained from the patients and approval was granted by the Research and Development Unit (RDU) of KomfoAnokye Teaching Hospital. Demographic data collected were age, gender, clinical presentations, surgical procedures performed and outcome of management. Data collected were analyzed using simple statistical methods and the SPSS 16.0 in determining the variables analyzed.
RESULTS During the period under review there were 1,208 patients diagnosed as cases of sinusitis of which 39 presented with intracranial complications; an incidence rate of 3.2%. The patients consisted of 27 males (69.2%) and 12 females (30.8%) with a male-tofemale ratio of 2.3: 1 as shown in Table 1. The patients' ages ranged between 11 and 42 years with a mean age ± standard deviation of (25.3± 4.4) years; 20.5% were between (11-15) years, 7.7% were between (16-25) years, 30.8% were between (26-30) years, 5% were between (31-35) years, 12.8% were between (36-40) years and 7.7% were between (41-45) years as shown in Table 2. All the patients presented with headache, 92.3% presented with fever, 25.6% presented with neck stiffness, 30.8% presented with nausea/vomit, 10.3% presented with sinus tenderness, 2.6% presented with hemiparesis, proptosis in 12.8% and 5.1% presented with lethargy as shown in Table 3 . 20.5% were diagnosed as cases of meningitis, 35.9% as epidural abscess, 25.7% as subdural abscess, 12.8% as cavernous sinus thrombosis which was diagnosed on basis of the clinical symptoms of very high temperature, headaches, proptosis and swelling of the
13
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
conjunctiva and the eyelids and 5.1% as cerebral abscess as shown in Table 4. Of all the patients 71.8% underwent sinus surgeries including frontal trephination in 15.4%, fronto-ethmoidectomy in 10.3%, ethmoidectomy in 5.1% and antrostomy in 41.0%. Neurosurgical operations were performed in 66.7% of the patients consisting of Burr-hole drainage in 35.9% and craniotomy plus evacuation in 30.8% as shown in Table 5. All the patients survived except 7.7% who died; 2.6% survived with a disability (Hearing impairment) as shown in Table 6.
DISCUSSION Intracranial complications of sinusitis present diagnostic challenges, because many patients may lack a history of sinusitis and present with vague, non-localizing signs and symptoms.Sinugenic intracranial complications are rare. This study had an incidence rate of 3.2% which is comparable with the study reported by Hicks et al [1] and Gianoni et al [2]. Intracranial complications of sinusitis in this study seemed to be more frequent in males than in females with a male-to-female ratio of 2.3: 1. Jones et al reported 3: 1, Kombogiorgas reported 10: 1 and Venkatesh et al reported 1.8: 1. This predominance in the male gender is difficult to explain. In this study the major clinical presentations were headache (100%), fever (92.3%), nausea/vomiting (30.8%) etc., which compare with the findings of Hicks et al [1] and Kombogiorgas et al [6]. Headache, fever, nausea/vomiting are some of the major clinical manifestations in sinugenic intracranial complications in all the studies accessed, including this study. Intracranial complications in this study included epidural abscess (35.9%), subdural empyema (25.6%), meningitis (20.5%); this is comparable with the findings of Younis et al [5]. Germiller et al advocated that neurosurgical and otorhinolaryngological surgical intervention may improve outcomes and reduce short-term and long-term sequelae [8]. CONCLUSION Computerized tomographic imaging of the head coupled with early diagnosis and management collaboration by the physician, otorhinolarygologistand the neurosurgeon
14
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
have considerably improved the outcome and sequelae in patients who present with intracranial complications of sinusitis in KATH.
REFERENCES 1. Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and Managing Intracranial Complications of Sinusitis in Children: A Retrospective Series, Pediatric Infectious Disease Journal: March 2011; 30(3): 222-226. 2. Gianoni CM, Stewart MG, Alford EL. Intracranial complications of sinusitis. Laryngoscope. 1997; July, 107(7): 863-7. 3. Jones RL, Violaris NS, Chavda SV, Pahor AL. Intracranial complications of sinusitis: the need for aggressive management. The Journal of Laryngology & Otology. November 1995; 109 (11): 1061-1062. 4. Sable NS, Hengerer A, Powell KR. Acute frontal sinusitis with intracranial complications. Pediatr Infect Dis 1984; 3: 58-61. 5. YounisRT,Laser RH, Anand KV. Intracranial complications of sinusitis: a 15 year review of 39 cases. Ear, Nose & Throat Journal, Sept. 2002; 81(9): 636-639. 6. Kombogiorgas D, Sth R, Athwal R, Modha J, Singh J. Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg 2007; 21 (6): 603-9. 7. Venkatesh MS, Pandey P, Devi BI, Khanapure K, Satish S, Sampath S, Chandramouli BA, Sestry KV. Paediatricinfratentorial subdural empyema: analysis of 14 cases. J Neurosurg. 2006; 105 (5): 370-7. 8. Germiller JA, Monin DL, Sparano DM, Tom lWC. Intracranial complications of Sinusitis in Children and Adolescents and Their outcomes. Arch Otolaryngol Head Neck Surg. 2006; 1(32): 969-976.
15
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Table 1: Gender distribution of participants Gender
Frequency
Percentage
Males
27
69.2
Females
12
30.8
Total
39
100
Male:female ratio = 2.3: 1
Table 2: Age distribution of participants Age range (years)
Frequency
Percentage %
11-15
8
20.5
16-20
3
7.7
21-25
12
30.8
26-30
6
15.4
31-35
2
5.1
36-40
5
12.8
41-45
3
7.7
Mean age ± SD (25.3 ± 4.4) years
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JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Table 3: Clinical presentations Clinical presentation
Frequency
Percentage %
Headache
39
100
Fever
36
92.3
Neck stiffness
10
25.6
Nausea/vomit
12
30.8
Sinus tenderness
4
10.3
Hemiparesis
1
2.6
Letargy
2
5.1
Proptosis, swollen conjunctiva/eyelid
5
12.8
Table 4: Pattern of intracranial complication Intracranial complication
Frequency
Percentage %
8
20.5
Epidural abscess
14
35.9
Subdural abscess
10
25.7
Cavernous sinus thrombosis
5
12.8
Cerebral abscess
2
5.1
Meningitis
Table 5: Surgical management modality
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JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Surgical procedure performed
Frequency
Percentage %
28
71.8
Frontal trephination
6
15.4
Fronto-ethmoidectomy
4
10.3
Ethmoidectomy
2
5.1
Antral lavage/ antrostomy
16
41.0
Neurosurgical
26
66.7
Burr hole
14
35.9
Craniotomy
12
30.8
Otorhinolaryngological
Table 6: Management outcome Outcome
Frequency
Percentage %
35
89.7
Successful with disability
1
2.6
Unsuccessful management
3
7.7
Successful management
Figure 1: Computerized tomography of the sinuses of a patient/ Tomographie informatisée des sinus d'un patient
18
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Figure 2: Computerized tomography of the brain of a patient/ Tomodensitométrie du cerveau d'un patient
19
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Figure 3: Neurosurgical procedure/ Procédure neurochirurgicales
20
PATTERN OF INTRACRANIAL COMPLICATIONS OF SINUSITIS IN KOMFO ANOKYE TEACHING HOSPITAL
*J. Opoku-Buabeng1, Owusu B2. 1
Department of Ear, Nose and Throat (ENT), 2Neurosurgery Unit
KomfoAnokye Teaching Hospital, Kumasi, Ghana. E-Mail: [email protected] *Correspondence Grant support: None Conflict of Interest:
None
ABSTRACT Background:Patients with intracranial complications of sinusitis present a major challenge to all, physicians, otorhinolaryngologists and neurosurgeons, because the purulent collection can be in areas that are not easily accessible like the interhemispheric and subfrontal areas of the brain and continue to exert toxic effects that account for the morbidity and mortality associated. Aims and Objectives:To determine the incidence, symptoms, pattern, the management and the outcome of intracranial complications of sinusitis in KomfoAnokye Teaching Hospital, Kumasi, Ghana. Study Design: It was a prospective study of 39 patients who presented with intracranial complicationsof sinusitis. Setting: The study was carried out in KomfoAnokye Teaching Hospital (KATH), in Kumasi, Ghana.
10
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Patients and Methods: Patients who reported to KATH with sinugenic intracranial complications from January 2007 to December 2011 were prospectively studied using a standard proforma to record details of their demographic, clinical presentations, management data and outcome. Results: The incidence rate of sinugenic intracranial complications was 3.2%. They consisted of 69.2% males and 30.8% females, with a male-to-female ratio of 2.3: 1 and a mean age of 25.3 years. The most common symptoms were headache in 100%, fever in 92.3%, nausea / vomiting in 30.8%, sinus tenderness in 10.3%, hemiparesis in 2.6%, proptosis in 12.8% and lethargy in 5.1% of the cases. Epidural abscess was the commonest sinugenic intracranial complication in 35.9%, sudural abscess in 25.6%, meningitis in 20.5%, cavernous sinus thrombosis in 12.8% and cerebral abscess in 5.2%. Sinus surgeries were performed in 71.8% and neurosurgical operations were also performed in 66.7% of the cases. Single modality treatment of sinus surgery was performed in 33.3% of the cases, neurosurgical procedure in 28.2% whereas a combined treatment was performed in 38.5%. The management outcomes were successful in 87.7% and unsuccessful in 2.6%. Conclusion:Even though the incidence rate of sinugenic intracranial complications was minimal as compared to some literatures, they still require a prompt and a collaborative management of the physician, otorhinolaryngologist and the neurosurgeon. Key words: Sinugenic intracranial complications, Epidural abscess, Headache, Sinus surgery, Neurosurgical operation.
INTRODUCTION Intracranial complications of sinusitis remain a challenge and contemporary topic of medical and surgical emergency. The anatomical relationship between the paranasal sinuses and the brain make it easy for sinusitis to spread and produce intracranial complications. Hicks et al reported an incidence rate of 3.9% in a retrospective study in children [1]. Giannoni et al reviewed 212 patients with intracranial suppurative infection and found out that sinugenic infection was identified in 12 (5.7%) [2].
11
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Hicks et al identified the symptoms of intracranial complications to be headache (92.0%), fever (85%), nausea/vomiting (62.0%) sinus tenderness (31.0%) and lethargy (23.0%). Jones et al reported in Birmingham (UK) of 12 cases consisting of 9 males and 3 females, aged (16-74) years (mean age of 35.5 years). They stressed the importance of the combined management by the otorhinolaryngologist and the neurosurgeon. In their study 9 of the patients underwent sinus surgery of which 3 had frontal trephination, 4 had frontoethmoidectomy and 2 underwent sphenoid drainage. Besides these same patients underwent neurosurgical procedures of which 7 had craniotomy and 3 had Burr-hole drainage [3]. Sable et al reported an incidence rate of (20-40 %) [4]. Younis et al reported 82 patients admitted in University of Mississippi Medical Centre between January 1, 1985 and December 31, 1999 for treatment of complications of sinusitis. They found that 39 patients had intracranial complications;53.8% had meningitis, 15.4% had epidural abscess, 12.8% had subdural abscess, 10.3% had intracerebral abscess, whereas Pott’s puffy tumour and cavernous sinus thrombosis was found in 2.6% each of the cases [5]. Kombogiorgas et al reported in a study in which they investigated the outcome of neurosurgical treated children with sinusitis induced complications (SIC) retrospectively. Of the 11 patients studied upon, 10 were males whereas 1 was a female. The patients presented with the following symptoms, headache (81.8%), vomiting (45.5) % swelling of the forehead (45.5%). These patients were managed with sinus surgery of which 8 underwent frontal trephination, whereas neurosurgically 8 underwent Burr-hole drainage. Theyidentified 2 cases with epilepsy as an outcome after the management [6]. Venketesh et al also reported in Bengalore, India of 14 patients consisting of 9 males and 5 females of which craniotomy were performed in 79% whereas Burr-hole drainage in 21%. They reported no sequelae in their management [7].
PATIENTS AND METHOD This was a 5-year prospective study conducted at the Ear, Nose and Throat (ENT) clinic and the Neurosurgical unit of the KomfoAnokye Teaching Hospital (KATH) Kumasi, Ghana between January 2007 and December 2011.
12
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
This facility is the second largest teaching hospital in the country and it provides services to most people from the middle belt and the northern part of the country. These were patients who were diagnosed as cases of sinugenic intracranial lesions, having undergone ENT examinations, neurological clinical examinations and having taken a computerized tomography imaging of the head and neck as shown in Figures 1 and 2. The patients were admitted to the wards, managed with intravenous antibiotics, analgesic/antipyretics and steroid. Some of the patients underwent neurosurgical and sinus surgeries as shown in Figure 3. Consents were obtained from the patients and approval was granted by the Research and Development Unit (RDU) of KomfoAnokye Teaching Hospital. Demographic data collected were age, gender, clinical presentations, surgical procedures performed and outcome of management. Data collected were analyzed using simple statistical methods and the SPSS 16.0 in determining the variables analyzed.
RESULTS During the period under review there were 1,208 patients diagnosed as cases of sinusitis of which 39 presented with intracranial complications; an incidence rate of 3.2%. The patients consisted of 27 males (69.2%) and 12 females (30.8%) with a male-tofemale ratio of 2.3: 1 as shown in Table 1. The patients' ages ranged between 11 and 42 years with a mean age ± standard deviation of (25.3± 4.4) years; 20.5% were between (11-15) years, 7.7% were between (16-25) years, 30.8% were between (26-30) years, 5% were between (31-35) years, 12.8% were between (36-40) years and 7.7% were between (41-45) years as shown in Table 2. All the patients presented with headache, 92.3% presented with fever, 25.6% presented with neck stiffness, 30.8% presented with nausea/vomit, 10.3% presented with sinus tenderness, 2.6% presented with hemiparesis, proptosis in 12.8% and 5.1% presented with lethargy as shown in Table 3 . 20.5% were diagnosed as cases of meningitis, 35.9% as epidural abscess, 25.7% as subdural abscess, 12.8% as cavernous sinus thrombosis which was diagnosed on basis of the clinical symptoms of very high temperature, headaches, proptosis and swelling of the
13
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
conjunctiva and the eyelids and 5.1% as cerebral abscess as shown in Table 4. Of all the patients 71.8% underwent sinus surgeries including frontal trephination in 15.4%, fronto-ethmoidectomy in 10.3%, ethmoidectomy in 5.1% and antrostomy in 41.0%. Neurosurgical operations were performed in 66.7% of the patients consisting of Burr-hole drainage in 35.9% and craniotomy plus evacuation in 30.8% as shown in Table 5. All the patients survived except 7.7% who died; 2.6% survived with a disability (Hearing impairment) as shown in Table 6.
DISCUSSION Intracranial complications of sinusitis present diagnostic challenges, because many patients may lack a history of sinusitis and present with vague, non-localizing signs and symptoms.Sinugenic intracranial complications are rare. This study had an incidence rate of 3.2% which is comparable with the study reported by Hicks et al [1] and Gianoni et al [2]. Intracranial complications of sinusitis in this study seemed to be more frequent in males than in females with a male-to-female ratio of 2.3: 1. Jones et al reported 3: 1, Kombogiorgas reported 10: 1 and Venkatesh et al reported 1.8: 1. This predominance in the male gender is difficult to explain. In this study the major clinical presentations were headache (100%), fever (92.3%), nausea/vomiting (30.8%) etc., which compare with the findings of Hicks et al [1] and Kombogiorgas et al [6]. Headache, fever, nausea/vomiting are some of the major clinical manifestations in sinugenic intracranial complications in all the studies accessed, including this study. Intracranial complications in this study included epidural abscess (35.9%), subdural empyema (25.6%), meningitis (20.5%); this is comparable with the findings of Younis et al [5]. Germiller et al advocated that neurosurgical and otorhinolaryngological surgical intervention may improve outcomes and reduce short-term and long-term sequelae [8]. CONCLUSION Computerized tomographic imaging of the head coupled with early diagnosis and management collaboration by the physician, otorhinolarygologistand the neurosurgeon
14
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
have considerably improved the outcome and sequelae in patients who present with intracranial complications of sinusitis in KATH.
REFERENCES 1. Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and Managing Intracranial Complications of Sinusitis in Children: A Retrospective Series, Pediatric Infectious Disease Journal: March 2011; 30(3): 222-226. 2. Gianoni CM, Stewart MG, Alford EL. Intracranial complications of sinusitis. Laryngoscope. 1997; July, 107(7): 863-7. 3. Jones RL, Violaris NS, Chavda SV, Pahor AL. Intracranial complications of sinusitis: the need for aggressive management. The Journal of Laryngology & Otology. November 1995; 109 (11): 1061-1062. 4. Sable NS, Hengerer A, Powell KR. Acute frontal sinusitis with intracranial complications. Pediatr Infect Dis 1984; 3: 58-61. 5. YounisRT,Laser RH, Anand KV. Intracranial complications of sinusitis: a 15 year review of 39 cases. Ear, Nose & Throat Journal, Sept. 2002; 81(9): 636-639. 6. Kombogiorgas D, Sth R, Athwal R, Modha J, Singh J. Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg 2007; 21 (6): 603-9. 7. Venkatesh MS, Pandey P, Devi BI, Khanapure K, Satish S, Sampath S, Chandramouli BA, Sestry KV. Paediatricinfratentorial subdural empyema: analysis of 14 cases. J Neurosurg. 2006; 105 (5): 370-7. 8. Germiller JA, Monin DL, Sparano DM, Tom lWC. Intracranial complications of Sinusitis in Children and Adolescents and Their outcomes. Arch Otolaryngol Head Neck Surg. 2006; 1(32): 969-976.
15
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Table 1: Gender distribution of participants Gender
Frequency
Percentage
Males
27
69.2
Females
12
30.8
Total
39
100
Male:female ratio = 2.3: 1
Table 2: Age distribution of participants Age range (years)
Frequency
Percentage %
11-15
8
20.5
16-20
3
7.7
21-25
12
30.8
26-30
6
15.4
31-35
2
5.1
36-40
5
12.8
41-45
3
7.7
Mean age ± SD (25.3 ± 4.4) years
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JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Table 3: Clinical presentations Clinical presentation
Frequency
Percentage %
Headache
39
100
Fever
36
92.3
Neck stiffness
10
25.6
Nausea/vomit
12
30.8
Sinus tenderness
4
10.3
Hemiparesis
1
2.6
Letargy
2
5.1
Proptosis, swollen conjunctiva/eyelid
5
12.8
Table 4: Pattern of intracranial complication Intracranial complication
Frequency
Percentage %
8
20.5
Epidural abscess
14
35.9
Subdural abscess
10
25.7
Cavernous sinus thrombosis
5
12.8
Cerebral abscess
2
5.1
Meningitis
Table 5: Surgical management modality
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JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Surgical procedure performed
Frequency
Percentage %
28
71.8
Frontal trephination
6
15.4
Fronto-ethmoidectomy
4
10.3
Ethmoidectomy
2
5.1
Antral lavage/ antrostomy
16
41.0
Neurosurgical
26
66.7
Burr hole
14
35.9
Craniotomy
12
30.8
Otorhinolaryngological
Table 6: Management outcome Outcome
Frequency
Percentage %
35
89.7
Successful with disability
1
2.6
Unsuccessful management
3
7.7
Successful management
Figure 1: Computerized tomography of the sinuses of a patient/ Tomographie informatisée des sinus d'un patient
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JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Figure 2: Computerized tomography of the brain of a patient/ Tomodensitométrie du cerveau d'un patient
19
JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS VOLUME 2 NUMBER 4, OCTOBER-‐DECEMBER 2012
Figure 3: Neurosurgical procedure/ Procédure neurochirurgicales
20
