The impact of endoscopic sinus surgery in pediatric patients with sinogenic intracranial infection: A systematic review and meta-analysis

Elysia Grose; Jenny B Xiao; Evan Fang; Brigitte Routhier-Chevrier; Jennifer M Siu; Nikolaus E Wolter

doi:10.1016/j.ijporl.2024.112176

The impact of endoscopic sinus surgery in pediatric patients with sinogenic intracranial infection: A systematic review and meta-analysis

Int J Pediatr Otorhinolaryngol. 2024 Nov 26:187:112176. doi: 10.1016/j.ijporl.2024.112176. Online ahead of print.

Authors

Elysia Grose¹, Jenny B Xiao², Evan Fang³, Brigitte Routhier-Chevrier¹, Jennifer M Siu¹, Nikolaus E Wolter⁴

Affiliations

¹ The Hospital for Sick Children, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada, M5G 1X8.
² Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada, V6T 1Z3.
³ Faculty of Medicine, McMaster University, Hamilton, Ontario, Canada, L8N 3Z5.
⁴ The Hospital for Sick Children, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada, M5G 1X8. Electronic address: nikolaus.wolter@sickkids.ca.

PMID: 39608152
DOI: 10.1016/j.ijporl.2024.112176

Abstract

Objective: This review aims to elucidate the role of endoscopic sinus surgery (ESS) on the outcomes of pediatric patients with sinogenic intracranial infections.

Methods: MEDLINE, Embase, and the Cochrane library were searched for articles that described the outcomes in pediatric patients who had intracranial complications of acute rhinosinusitis (ARS) and underwent ESS with or without open neurosurgical approaches (ONA) or external sinus approaches (ESA). Primary outcomes of interest include mortality, revision surgery, length of stay and neurological sequelae. Random effects meta-analysis was performed.

Results: Forty-eight articles met the final eligibility criteria, totaling 710 pediatric patients and 905 intracranial complications. The most common complications were subdural empyema (n = 261, 29 %), epidural abscess (n = 213, 24 %), and Pott's Puffy tumor (PPT) (n = 95, 10 %). When comparing patients who underwent ESS (alone or combined with ONA) to those who underwent ONA only, there was a decreased risk of revision surgery (RR = 0.66, 95 % CI = 0.38-1.12 and RR = 0.63, 95 % CI = 0.36-1.09, respectively) and decreased risk of neurological sequelae (RR = 0.65, 95 % CI = 0.15-2.74 and RR = 0.50, 95 % CI = 0.20-1.26, respectively), however these differences were not statistically significant. When patients who underwent combined intervention were compared to ESS only, the risk of revision surgery (RR = 1.04, 95 % CI = 0.62-1.72) and neurological sequelae (RR = 0.99, 95 % CI = 0.37-2.64) were similar. Risk of mortality was minimal and similar across all interventions.

Conclusion: The current study including primarily small retrospective studies found no statistically significant differences between children who received ESS alone, ESS with ONA or ONA alone, on mortality, revision surgery, length of stay and neurological sequelae. Although ESS may be beneficial for managing certain pediatric sinogenic intracranial infections, its true effectiveness is difficult to determine due to the variability in the types of intracranial complications and the inconsistent extent of ESS procedures reported in the literature.

Keywords: Brain abscess; Endoscopic sinus surgery; Epidural abscess; Pediatric sinusitis; Subdural empyema.

Publication types

Review