Hostname: page-component-848d4c4894-ttngx Total loading time: 0 Render date: 2024-06-07T12:22:07.128Z Has data issue: false hasContentIssue false
  • English
  • Français

Single stage, transmastoid approach for otogenic intracranial abscess

Published online by Cambridge University Press:  16 July 2009

K P Morwani  and
N Jayashankar
K P Morwani
Affiliation:
Skull Base Group, Dr Balabhai Nanavati Hospital and Medical Research Centre, and the Shri H Bhagwati Municipal General Hospital (KPM), Mumbai, India
N Jayashankar*
Affiliation:
Skull Base Group, Dr Balabhai Nanavati Hospital and Medical Research Centre, and the Shri H Bhagwati Municipal General Hospital (KPM), Mumbai, India
*
Address for correspondence: Dr Jayashankar Narayan, Narayan Clinic, 14-A Road, Khar West, Mumbai 400 052, India. Fax: 91 22 2600 5520 E-mail: drnarayanj@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the treatment of intracranial abscess of otogenic origin, and to study the outcome measures of single stage treatment of the otogenic focus and drainage of intracranial abscess via a transmastoid approach.

Study design:

Retrospective case review.

Setting:

Dr Balabhai Nanavati Hospital and Medical Research Centre, Mumbai, India, an academic tertiary referral centre, and Shri H Bhagwati Municipal General Hospital, Mumbai, India, an academic secondary referral centre.

Patients:

Seventy-three patients with intracranial abscess secondary to otogenic pathology, confirmed by computed tomographic scanning.

Intervention:

Single stage treatment of the ear pathology and drainage of intracranial abscess via a transmastoid approach, performed by the senior author (KPM).

Results:

Of the 73 patients, 12 were lost to follow up and were excluded from the study. Outcomes for the remaining 61 patients were known, and these patients were followed up for at least two years. Adults were more commonly affected by otogenic intracranial abscess than children, with a male preponderance. Otogenic intracranial abscess was associated with both cholesteatomatous (41 per cent) and non-cholesteatomatous ears (59 per cent). All cases were treated with transmastoid drainage of the intracranial abscess and canal wall up or down tympanomastoidectomy, depending on the ear pathology. Two cases developed post-operative cerebrospinal fluid leakage (3 per cent), and another two cases developed meningitis (3 per cent). Five patients had recurrent abscess; two of these patients (3 per cent) died but were included in the study. Three patients had residual abscess, improved with additional management.

Conclusion:

In this series, the low morbidity and mortality rate, combined with a shorter hospital stay, suggest that single stage, transmastoid drainage of intracranial abscess and concurrent treatment of the otogenic pathology is an effective treatment for otogenic intracranial abscess.

Keywords

Otitis MediaCerebral AbscessMastoidectomyOtologic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 123 , Issue 11 , November 2009 , pp. 1216 - 1220
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented at the Otology, Neurotology and Lateral Skull Base Surgery Workshop, 23–25 December 2006, Mumbai, India.

References

1Shu-Yuan, Y. Brain abscess: a review of 400 cases. J Neurosurg 1981;55:794–9Google Scholar
2Kornblut, AD. Cerebral abscess – a recurrent otological problem. Laryngoscope 1972;82:1541–56CrossRefGoogle Scholar
3Gower, D, McGruit, WF. Intracranial complications of acute and chronic infectious ear disease: a problem still with us. Laryngoscope 1983;91:1028–33CrossRefGoogle Scholar
4Wolfowitz, B. Otogenic intracranial complication. Arch Otolaryngol 1972;96:220–2CrossRefGoogle Scholar
5Garap, JP, Dubey, SP. Canal-down mastoidectomy: experience in 81 cases. Otol Neurotol 2001;22:451–6CrossRefGoogle ScholarPubMed
6Hafidh, MA, Keogh, I, Walsh, RM, Walsh, M, Rawluk, D. Otogenic intracranial complications. A 7 year retrospective review. Am J Otolaryngol 2006;27:390–5CrossRefGoogle ScholarPubMed
7Singh, B, Maharaj, TJ. Radical mastoidectomy: its place in otitic intracranial complications. J Laryngol Otol 1993;107:1113–18CrossRefGoogle ScholarPubMed
8Kurien, M, Job, A, Mathew, J, Chandy, M. Otogenic intracranial abscess. Concurrent craniotomy and mastoidectomy – changing trends in a developing country. Arch Otolaryngol Head Neck Surg 1998;124:1353–6CrossRefGoogle ScholarPubMed
9Bhatia, S, Karmarkar, S, DeDonato, G, Mutlu, C, Taibah, A, Russo, A. Canal wall down mastoidectomy: causes of failure, pitfalls and their management. J Laryngol Otol 1995;109:583–9CrossRefGoogle ScholarPubMed
10Sanna, M, Dispenza, F, Flanagan, S, De Stafano, A, Falcioni, M. Management of chronic otitis by middle ear obliteration with blind sac closure of the external auditory canal. Otol Neurotol 2008;29:19–22CrossRefGoogle ScholarPubMed
11Penido Nde, O, Borin, A, Iha, LC, Suguri, VM, Onishi, E, Fukuda, Y et al. Intracranial complications of otitis media: 15 years of experience in 33 patients. Otolaryngol Head Neck Surg 2005;132:37–42CrossRefGoogle ScholarPubMed
12Mamelak, AN, Mampalam, TJ, Obana, WG, Rosenblum, ML. Improved management of multiple brain abscesses: a combined surgical and medical approach. Neurosurgery 1995;36:76–85CrossRefGoogle ScholarPubMed
13Migirov, L, Duvdevani, S, Kronenberg, J. Otogenic intracranial complications: a review of 28 cases. Acta Otolaryngol 2005;125:819–22CrossRefGoogle ScholarPubMed