Treatment of Severe Intracranial Extension of Frontal Sinusitis: Case Report and Review of the Literature

Introduction : Although rhinosinusitis is very common at an estimated incidence of 1 in 8 individuals in the United States, serious complications of rhinosinusitis in the era of antibiotics are exceedingly rare. Infectious spread to the intracranial cavity can result in significant morbidity and mortality. The timing and methods of treatment are not clearly delineated and likely need to be specific to each individual clinical situation. Objectives : To report the case of a patient with severe brain abscess secondary to frontal sinusitis. Study Design : Case report and literature review. Methods : Literature review of intracranial complications of frontal sinusitis as well as minimally invasive treatment options and discussion of an illustrative case. Case Report : Cranial imaging of a fifty seven year old diabetic male presenting with altered mental status demonstrated frontal sinusitis and dehiscence of the posterior table of the frontal sinus, resulting in a large frontal intraparenchymal intracranial abscess with extension into the ventricular system. Emergent surgical treatment included an endoscopic endonasal Draf III frontal sinusotomy with simultaneous burr hole craniostomy for abscess drainage and ventriculostomy placement. Following an extended course of intravenous antibiotics, the patient demonstrated full resolution of the infection. Conclusion : The treatment of large brain abscess secondary to sinusitis is a challenge. We presented a case of a patient who had an enormous frontal lobe abscess with extension to the ventricle treated without craniotomy. The control of the source of the infection with wide opening of the affected sinus, in our case the Draf III frontal sinusotomy, seems to be key in the treatment plan to terminate the infectious process. Fig. 1 MRI revealing sagittal extension of frontal lobe abscess to the ventricular system.