Younis Ramzi T, Lazar Rande H, Anand Vinod K
Division of Otolaryngology, Department of Surgery, University of Mississippi Medical Center, Jackson, USA.
Ear Nose Throat J. 2002 Sep;81(9):636-8, 640-2, 644.
Despite improvements in antibiotic therapies and surgical techniques, sinusitis still carries a risk of serious and potentially fatal complications. We examined the charts of 82 patients who had been admitted to the University of Mississippi Medical Center between Jan. 1, 1985, and Dec. 31, 1999, for treatment of complications of sinusitis. Of these 82 patients, 43 had orbital complications and 39 had intracranial complications. In this article, we describe our findings in those patients who had intracranial complications (our findings in patients with orbital complications will be reported in a future article). The most common intracranial complication was meningitis; others were epidural abscess, subdural abscess, intracerebral abscess, Pott's puffy tumor, and superior sagittal sinus thrombosis. Most patients with meningitis were treated with drug therapy only; patients with abscesses were generally treated with intravenous antibiotics and drainage of the affected sinus and the abscess. Advancements in antibiotic therapy, endoscopic surgery, imaging studies, and computer-assisted surgery have helped improve outcomes. Management of these patients should be undertaken immediately and is best achieved via a multidisciplinary approach, involving the otolaryngologist, neurosurgeon, radiologist, anesthesiologist, infection disease specialist, pediatrician, internist, and others.
尽管抗生素治疗和外科技术有所改进，但鼻窦炎仍有发生严重且可能致命并发症的风险。我们查阅了1985年1月1日至1999年12月31日期间入住密西西比大学医学中心接受鼻窦炎并发症治疗的82例患者的病历。在这82例患者中，43例有眼眶并发症，39例有颅内并发症。在本文中，我们描述了那些有颅内并发症患者的研究结果（我们在有眼眶并发症患者中的研究结果将在未来的文章中报告）。最常见的颅内并发症是脑膜炎；其他的有硬膜外脓肿、硬膜下脓肿、脑内脓肿、波特氏水肿性骨炎和上矢状窦血栓形成。大多数脑膜炎患者仅接受药物治疗；脓肿患者一般接受静脉抗生素治疗以及对患侧鼻窦和脓肿进行引流。抗生素治疗、内镜手术、影像学检查和计算机辅助手术的进展有助于改善治疗效果。这些患者的治疗应立即进行，最好通过多学科方法实现，涉及耳鼻喉科医生、神经外科医生、放射科医生、麻醉科医生、感染病专家、儿科医生、内科医生等。
