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Evaluation of treatment approaches for sinogenic intracranial abscess in children
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  • Kristijonas Milinis,
  • Janaki Thiagarajan,
  • Sujata De,
  • Ravi Sharma,
  • Samuel Leong,
  • Ajay Sinha,
  • Sunil Sharma
Kristijonas Milinis
Royal Liverpool and Broadgreen University Hospitals NHS Trust

Corresponding Author:[email protected]

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Janaki Thiagarajan
University of Liverpool
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Sujata De
University of Liverpool Faculty of Health and Life Sciences
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Ravi Sharma
Alder Hey Children’s Hospital
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Samuel Leong
University Hospital Aintree
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Ajay Sinha
Alder Hey Children’s Hospital
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Sunil Sharma
Barts Health NHS Trust
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Objectives: To evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. Design: Retrospective cohort study. Setting: A single paediatric tertiary unit. Participants: Patients younger than 18 years with radiologically confirmed intracranial abscess including subdural empyema (SDE), epidural (EDA) or intraparenchymal (IPA) abscess secondary to sinusitis. Main outcome measures: The rates of return to theatre, the length of hospital stay (LOS), death <90 days and neurological disability (ND) at 6 months. Results: A cohort of 39 consecutive patients (41% male, mean age 11.5) presenting between 2000-2020 were eligible for inclusion. SDE was the most common intracranial complication (n=25, 64%) followed by EDA (n=12, 31%) and IPA (n=7, 18%). The mean LOS was 42 days (SD 16). Sixteen patients (41%) were managed with combined ENT and neurosurgical interventions, 15 (38.5%) underwent ENT procedure alone and 4 (10.3%) had neurosurgical only drainage. Four patients initially underwent non-operative management. The rates of return to theatre, ND and 90-day mortality were 19 (48.7%), 9 (23.1%) and 3 (7.7%) respectively and were comparable across the four treatment arms. In the univariate logistic regression, only the size of an intracranial abscess (10mm) was found be associated with an increased likelihood of return to theatre (odds radio 7, confidence interval 1.09-45.1), while combined ENT and neurosurgical intervention did not result in improved outcomes. Conclusion: Sinogenic intracranial abscesses are associated with a significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.