Surgical treatment of multiple bilateral brain abscesses and subdural empyas in a 6-year-old child with purulent rhinosinusitis

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Abstract

Introduction. Bacterial brain abscesses and subdural empyema are often rare complications of rhinosinusitis, which is especially important in pediatric practice. Intracranial purulent clusters are life-threatening diseases which require urgent, and as a rule, surgical management.

Purpose. To illustrate successful surgical treatment of a patient with multiple bilateral brain abscesses and subdural empyemas as a result of purulent inflammation - paranasal sinusitis, which had not been diagnosed at the prehospital stage.

Material and methods. A case of a 6-year-old boy with multiple bilateral brain abscesses and subdural empyemas is described in the article. The patient had antibacterial therapy; paranasal sinuses were sanitized; all intracranial purulent foci were removed with minimally invasive approaches and accurate calculations based on findings of MRI examination.

Results. It had been confirmed that abscesses and subdural empyemas in the described patient was a complication of purulent inflammation in paranasal sinuses. To control treated foci and to exclude development of new purulent intracranial clusters in dynamics, multiple MRI examinations of the brain were performed. For successful management of purulent foci, the technique of incision, drainage, sanitation with antiseptic solutions and intraoperative exudate aspiration was applied.

Conclusion. Abscesses and empyemas of children’s brain are serious, life-threatening pathologies that always require hospitalization and emergency measures. Multiple abscesses and subdural empyemas is, as a rule, complication of rhinosinusitis. Multiple dynamic CT/MRI examinations of the brain is of a key importance, both for controlling removed foci and for excluding development of new purulent intracranial clusters. Active surgical tactics in the combination with antibacterial therapy leads to successful outcomes in patients with intracranial purulent lesions complicating the course of rhinosinusites.

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About the authors

Ruslan N. Asadov

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Author for correspondence.
Email: r.asadov@mail.ru
ORCID iD: 0000-0001-7848-1658

neurosurgeon, Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Россия, 119620 Moscow

A. R. Tekoyev

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0002-4006-6499
Россия, 119620 Moscow

L. R. Tumanyan

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0002-2295-3051
Россия, 119620 Moscow

M. V. Indereykin

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0001-9260-4036
Россия, 119620 Moscow

Е. N. Vrublevskaya

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0001-7312-5945
Россия, 119620 Moscow

A. I. Krapivkin

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0002-4653-9867
Россия, 119620 Moscow

S. G. Vrublevskiy

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0001-9400-7673
Россия, 119620 Moscow

P. A. Romanov

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0002-1898-7769
Россия, 119620 Moscow

G. G. Prokopev

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0002-7148-5637
Россия, 119620 Moscow

M. E. Sarafanova

Voyno-Yasenetsky Scientific and Practical Center of Specialized Medical Care for Children

Email: r.asadov@mail.ru
ORCID iD: 0000-0002-2021-9742
Россия, 119620 Moscow

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Supplementary files

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1. JATS XML
2. Fig. 1. Primary MRI of the head of patient M., aged 6 years, upon admission: a – intracerebral abscess of the left frontal lobe (green arrow), empyema of the interhemispheric fissure on the right (blue arrow); б – empyema of the interhemispheric fissure on the right (blue arrows); в – subaponeurotic phlegmon in the left frontal-parietal region (red arrow); г – purulent maxillary sinusitis on the left.

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3. Fig. 2. MRI of the patient next day after hospitalization. A newly formed subdural empyema on the right above the lateral parts of the right hemisphere causing compression and dislocation of brain structures (arrow).

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4. Fig. 3. MRI of the head after the first surgical intervention: a – subdural empyema on the right above the lateral parts of the right hemisphere has regressed (orange arrow), enlarged empyema of the interhemispheric fissure on the right (blue arrows); б – enlarged intracerebral abscess of the left frontal lobe (green arrow).

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5. Fig. 4. MRI of the head after the second intervention: a – subdural empyema on the right above lateral parts of the right hemisphere has regressed (orange arrow); abscess of the left frontal lobe was evacuated (green arrow); б, в – regression of the empyema in posterior parts of the interhemispheric fissure with persisting empyema in anterior parts of the interhemispheric fissure (blue arrows).

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6. Fig. 5. MRI of the head after the third surgery : a – coronary section; б – axial sections; в – parasagittal section. A newly formed abscess in basal parts of the right frontal lobe of the brain (yellow arrow). Empyema in the anterior sections on the right has regressed (blue arrow).

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7. Fig. 6. MRI of the head of patient M., 6 y. o., before discharge from the hospital: а, б – axial sections; в – parasagittal section; г – coronary section. Intracranial purulent foci are not visualized.

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Copyright (c) 2023 Asadov R.N., Tekoyev A.R., Tumanyan L.R., Indereykin M.V., Vrublevskaya Е.N., Krapivkin A.I., Vrublevskiy S.G., Romanov P.A., Prokopev G.G., Sarafanova M.E.

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