Skull Base, Table of Contents Skull Base 2010; 20(5): 389-392DOI: 10.1055/s-0030-1254403 CASE REPORT © Thieme Medical Publishers Endonasal Trans-Ethmoidal Drainage of a Cerebral Abscess Vincent Patron1 , Stéphane Orsel1 , François Caire2 , Pascal Turlure3 , Jean-Pierre Bessède1 , Karine Aubry1 1Department of Head and Neck Surgery, Limoges University Hospital Center, Limoges, France 2Department of Neurosurgery, Limoges University Hospital Center, Limoges, France 3Department of Clinical Hematology and Cell Therapy, Limoges University Hospital Center, Limoges, France Recommend Article Abstract Buy Article ABSTRACT Cerebral abscesses are rare but often lethal complications of invasive Aspergillus sinusitis. Treatment is difficult and usually depends on a combination of neurosurgical drainage and intravenous antifungal therapy. We report a case of intracerebral frontal abscess in continuity with the anterior skull base in a 53-year-old immunocompromised female with invasive rhino-orbital aspergillosis. An aperture was created by drilling the anterior skull base during endonasal sinus surgery, and the abscess was drained through its lower pole. The aperture was left open after surgery to ensure complete abscess drainage. Follow-up at 8 months revealed no cerebrospinal fluid leak or meningitis, and no abscess recurrence. This case validates the feasibility of endonasal trans-ethmoidal drainage of intracranial abscesses. KEYWORDS Rhino-orbital sinusitis - invasive aspergillosis - brain abscess - endonasal sinus surgery - trans-ethmoidal access Full Text References REFERENCES 1 Mohindra S, Mukherjee K K, Chhabra R, Gupta S K, Gupta R, Khosla V K. Invasive intracranial aspergillosis: the management dilemmas. Surg Neurol. 2008; 69(5) 496-505 discussion 505 2 Nadkarni T, Goel A. Aspergilloma of the brain: an overview. J Postgrad Med. 2005; 51(Suppl 1) S37-S41 3 Levin L A, Avery R, Shore J W, Woog J J, Baker A S. The spectrum of orbital aspergillosis: a clinicopathological review. Surv Ophthalmol. 1996; 41(2) 142-154 4 Saleh H A, Bridger M W. Invasive aspergillosis of the paranasal sinuses: a medical emergency. J Laryngol Otol. 1997; 111(12) 1168-1170 5 Eviatar E, Lavi R, Fridental I, Gavriel H. Endonasal endoscopic drainage of frontal lobe epidural abscess. Isr Med Assoc J. 2008; 10(3) 239-240 6 Péloquin L, Mercier C, Cataphard I. Epidural abscess drainage using endoscopic sinus surgery: a first case in the literature. J Otolaryngol. 2003; 32(5) 338-340 7 Gerber M E, Myer III C M, Berger T S, Prenger E C. Endoscopic transsphenoidal drainage of an epidural abscess. Am J Otolaryngol. 1994; 15(4) 310-314 Vincent PatronM.D. Department of Head and Neck Surgery, Limoges University Hospital Center 2 avenue Martin Luther-King, 87000 Limoges, France Email: vtromps@yahoo.fr
