Maniglia A J, Goodwin W J, Arnold J E, Ganz E
Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve, University School of Medicine, Cleveland, Ohio.
Arch Otolaryngol Head Neck Surg. 1989 Dec;115(12):1424-9. doi: 10.1001/archotol.1989.01860360026011.
Nineteen cases of intracranial abscesses secondary to infection of the midface are reported. The most common underlying cause was bacterial sinusitis. Other etiologic factors included mucormycosis following steroid therapy, Wegener's granulomatosis, nasal dermoid cyst and sinus tract, tooth abscesses, aspergillosis following chemotherapy for leukemia, squamous cell carcinoma of the frontal sinus, infected methylmethacrylate plate for a prior skull fracture, and a case of gauze packing left in the sinus following surgery. Anaerobic organisms were the predominant cause of the abscesses. The most dangerous intracranial complication was subdural abscess, which occurred in seven patients in this series. Three of them died. Four cases of frontal and parietal lobe abscesses were treated with systemic antibiotics only. This approach has not been well emphasized in our literature. Steroid therapy should not be used for the treatment of sinus and orbital infections. It can result in dreadful complications. The overall mortality rate in this series was 21% (4 of 19), despite aggressive treatment and close cooperation between the neurosurgeon, otolaryngologist, and other specialists. Early diagnosis and adequate treatment are paramount.
本文报告了19例继发于面中部感染的颅内脓肿病例。最常见的潜在病因是细菌性鼻窦炎。其他病因包括类固醇治疗后发生的毛霉菌病、韦格纳肉芽肿、鼻皮样囊肿及窦道、牙脓肿、白血病化疗后发生的曲霉菌病、额窦鳞状细胞癌、既往颅骨骨折后感染的甲基丙烯酸甲酯板，以及1例术后鼻窦内遗留纱布填塞的病例。厌氧菌是脓肿的主要病因。最危险的颅内并发症是硬膜下脓肿，本系列中有7例患者发生，其中3例死亡。4例额颞叶脓肿仅采用全身抗生素治疗。这种方法在我们的文献中未得到充分强调。类固醇治疗不应应用于鼻窦和眼眶感染，其可导致严重并发症。尽管采取了积极治疗且神经外科医生、耳鼻喉科医生及其他专科医生密切合作，但本系列的总死亡率仍为21%（19例中有4例）。早期诊断和充分治疗至关重要。
