Miloundja Jérôme, Bamba Jules Samuel, Mouba John Florent, Ella Ondo Thimothée, Mwanyombet Lucien, Mandji Lawson Jean Marcel, N'zouba Léon
Hôpital D'instruction des Armées Omar, Bongo Ondimba Service d'ORL & CCF BP 20404 Libreville, Gabon.
Sante. 2011 Oct-Dec;21(4):215-20. doi: 10.1684/san.2011.0275.
To review the pathologic, diagnostic and therapeutic aspects of the cranioencephalic complications of bacterial sinusitis.
This retrospective study included children who underwent diagnostic imaging at the Omar Bongo Ondimba military hospital between January 2006 and December 2010 and treatment of cranioencephalic complications of sinusitis.
During the study period, 58 children were hospitalized with sinusitis, and eight (13.8%) had cranioencephalic complications for an annual incidence of 1.6% and a sex ratio of 5 boys to 3 girls. Their mean age was 13 years. Symptoms developed over a mean duration of 14 days (range: 3-45 days). The clinical picture was dominated by febrile headaches and neurologic signs. Palpation of the sinus pressure points was painful in all cases. Disorders of consciousness were found in five cases, with a mean Glasgow score of 9 (range: 7-13). Seven children had multifocal sinusitis and one frontal sinusitis. Five children had a subdural empyema, two associated with thrombophlebitis of the sagittal sinus, one with a brain abscess with thrombophlebitis of the sagittal sinus, and another with meningitis and thrombophlebitis of the sagittal sinus. Two children had osteomyelitis of the frontal sinus table, including a frontal lobe abscess for one. Another had multiple cerebral abscesses. Five children had sinus and neurosurgical drainage, two sinus drainage only, and one neurosurgical drainage only. Microbiology was positive for microbes in four cases: Streptococcus eqinus (one case), Staphylococcus aureus (one case), both S. pneumoniae and Haemophilus influenzae (one case), and Aerococcus viridans (one case). Outcome was favourable in seven cases, including four without sequelae. Two children had recurrences, and one died.
Diagnosis of the cranioencephalic complications of sinusitis rely on medical imagery. Early multidisciplinary therapeutic management is essential.
回顾细菌性鼻窦炎颅脑部并发症的病理学、诊断及治疗方面的情况。
这项回顾性研究纳入了2006年1月至2010年12月期间在奥马尔·邦戈·翁丁巴军事医院接受诊断性影像学检查并治疗鼻窦炎颅脑部并发症的儿童。
研究期间，58例儿童因鼻窦炎住院，其中8例（13.8%）发生颅脑部并发症，年发病率为1.6%，男女比例为5∶3。他们的平均年龄为13岁。症状出现的平均持续时间为14天（范围：3 - 45天）。临床表现以发热性头痛和神经体征为主。所有病例触诊鼻窦压痛点均有疼痛。5例出现意识障碍，格拉斯哥评分平均为9分（范围：7 - 13分）。7例为多灶性鼻窦炎，1例为额窦炎。5例发生硬膜下积脓，2例合并矢状窦血栓性静脉炎，1例合并脑脓肿及矢状窦血栓性静脉炎，另1例合并脑膜炎及矢状窦血栓性静脉炎。2例发生额窦骨板骨髓炎，其中1例合并额叶脓肿。另1例有多发性脑脓肿。5例接受了鼻窦及神经外科引流，2例仅接受鼻窦引流，1例仅接受神经外科引流。4例微生物学检查发现有微生物阳性：马肠链球菌（1例）、金黄色葡萄球菌（1例）、肺炎链球菌和流感嗜血杆菌（1例）、绿色气球菌（1例）。7例预后良好，其中4例无后遗症。2例复发，1例死亡。
鼻窦炎颅脑部并发症的诊断依赖医学影像学检查。早期多学科治疗管理至关重要。
