What are the possible intracranial complications of acute sinusitis (sinus infection)?

Updated: Mar 01, 2018
  • Author: Itzhak Brook, MD, MSc; Chief Editor: Michael Stuart Bronze, MD  more...
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Intracranial complications may occur as a result of direct extension through the posterior frontal sinus wall or through retrograde thrombophlebitis of the ophthalmic veins. Subdural abscess is the most common intracranial complication, although cerebral abscesses and infarction that result in seizures, focal neurological deficits, and coma may occur. Intracranial complications of sinusitis should be managed surgically with drainage of both the affected sinus and the cranial abscess.

In a retrospective review of 23 cases (8 epidural, 10 subdural, 2 intracerebral abscess, and 3 meningitis) of intracranial complications of sinusitis (ICS) to identify the role and effectiveness of endoscopic sinus surgery (ESS) in the acute setting of ICS, DelGuadio et al concluded that ESS did not alter the need for neurosurgical intervention, which was ultimately necessary in most patients, even those with lesions less than 1 cm. [53]

In the study by DelGuadio et al, of the 23 patients, 22 (96%) had radiologic evidence of frontal sinusitis with prefrontal or frontal lobe ICS at presentation. Medical therapy alone was successful in avoiding craniotomy in only 3 of 8 cases, and treatment with endoscopic sinus surgery and intravenous antibiotics was successful in avoiding craniotomy in only 1 of 6 patients. Of 23 patients, 18 required neurosurgical procedures (9 emergent procedures for abscesses more than 1 cm and 9 delayed procedures for persistent disease despite ICS less than 1 cm).

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