The prevalence of intracranial complications in pediatric frontal sinusitis

Summary

Objective

Intracranial extension of infection represents a serious complication of sinusitis but with no clearly documented prevalence. The frontal sinus with its unique anatomical characteristics, has been singled out as a catalyst for intracranial spread, but without solid evidence. Our objective was to determine the prevalence of intracranial complications in pediatric acute frontal sinusitis and to test the claimed association.

Methods

A retrospective chart review of all children (≤16 years of age) admitted over an 18 year period with sinusitis was undertaken in a tertiary children's hosiptal. Included were those with acute disease (<3 months duration) that required active medical and/or surgical management. Patients with history of conditions that predispose to rhinosinusitis or intracranial infections were excluded. Data collected included demographics, sinuses involved, intracranial complications and their types, aspects of management, imaging, and mortality.

Results

In our search 466 patients were included. Of these, 386 did not meet the inclusion criteria. Of the 80 remaining patients, 10 had no films or imaging data available for analysis. The 70 included patients ranged in age from 7 months to 15 years (mean 8.8, median 10). Forty-nine (70%) were males. Twenty-six required medical treatment and 44 (62.9%) required surgical therapy in addition. Forty-nine had orbital complications and 8 (11.4%) had intracranial complications. There was no mortality. The eight patients with intracranial complications ranged in age from 3 to 14 years (mean 12). Six were males. Of the 23 patients with frontal sinus involvement, 7 (30.4%) had intracranial complications. The odds ratio for developing intracranial complications if the frontal sinus was involved in the inflammatory process was 20 (95% CI 2.30–176.4).

Conclusion

There is a high probability of developing intracranial complications in children who present with acute frontal sinusitis to a tertiary care hospital. This should prompt all involved specialists to insist on detailed radiological evaluation in this group, to halt preventable mortality and morbidity.

Introduction

Despite the advances in the management of rhinosinusitis, many aspects of its epidemiology are as yet to be established [1]. It is not surprising then that the prevalence of sinogenic intracranial complications in children is poorly documented especially that the available sources are a handful of mixed pediatric and adult series with the exception of one publication [2], [3], [4]. Jones et al. in 2002, suggested that since the prevention of such morbid events is not feasible due to lack of specific precipitating factors, early detection is highly desirable [5].

On another note, the frontal sinus had been singled out as a prime catalyst and a common denominator in the pathogenesis of intracranial complications [6]. This had been attributed to its unique anatomy, but to date has never been a proven epidemiological association.

The objective of this study was to explore the prevalence of these complications in children with acute rhinosinusitis presenting to a tertiary care center and examine its association with frontal sinus involvement.