Treatment of pediatric extra-axial sinogenic infection: case series and literature review

  • Mandana BehbahaniEmail author
  • Laura Burokas
  • Clayton L. Rosinski
  • David M. Rosenberg
  • Nauman S. Chaudhry
  • Jonathan M. Sherman
  • Demitrios C. Nikas
Original Article



Analyze the clinical presentation, microbiology, outcomes, and medical and surgical treatment strategies of intracranial extension of sinogenic infection in pediatric patients.


A retrospective, single-center study of patients < 18 years of age, presenting with intracranial extension of bacterial sinogenic infections requiring surgical intervention over a 5-year period, was conducted. Electronic medical records were reviewed for age, sex, primary symptoms, duration of symptoms, presence of sinusitis at initial presentation, microorganisms isolated, mode of surgery, timing of surgery, length of stay, and neurologic sequelae.


Seventeen patients were identified; mean age was 10 years with 82.3% male predominance. Average duration of illness prior to presentation was 9.8 days, with 64.7% of patients displaying disease progression while on oral antibiotics prior to presentation. Sinusitis and intracranial extension were present in all patients upon admission. Simultaneous endoscopic endonasal drainage and craniotomy were performed on 70.5% of the patients, with the remaining 29.5% undergoing endonasal drainage only. Of the patients who underwent simultaneous endoscopic endonasal drainage and craniotomy, 17.6% required repeat craniotomy and 5.8% required repeat sinus surgery. The most commonly isolated organisms were S. intermedius (52.9%), S. anginosus (23.5%), and S. pyogenes (17.6%). All patients were treated postoperatively antibiotic on average 4–6 weeks. Frequently occurring long-lasting complications included seizures (29.4%) and focal motor deficits (17.6%); learning disability, anxiety disorders, impaired cognition, and sensory deficits occurred less frequently.


In the case of intracranial extension of bacterial sinogenic infection, early identification and surgical treatment are crucial to avoid neurological sequelae.


Pott’s puffy tumor Pediatric sinogenic infection Intracranial infection Surgical management of sinogenic infections 


CT scan

computerized tomography scan




magnetic resonance imaging


Pott’s puffy tumor


Compliance with ethical standards

Conflict of interest

I, Mandana Behbahani, certify that this manuscript is original, it has not been previously published, and it is a unique submission not being considered for publication with any other source in any medium. All authors have read and approved the submitted manuscript. There is no conflict of interest or financial interests to declare for any of the authors on this paper. Thank you again for your consideration.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of NeurosurgeryAdvocate Children’s HospitalOak LawnUSA
  3. 3.University of Illinois College of MedicineChicagoUSA
  4. 4.Department of OtolaryngologyAdvocate Children’s HospitalOak LawnUSA

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