Neurological Complications of Sinusitis

1. Ade Wijaya, MD – March 2019

2. Introduction
 Sinusitis: sinus inflammation
 Acute < 4 weeks, subacute 4-12 weeks, chronic > 12 weeks
 Bacterial and fungal
 Rare
 High morbidity and mortality
Tandon S, Beasley N, Swift AC. Changing trends in intracranial abscesses secondary to ear and sinus disease. J Laryngol Otol.2009;123(3):283–8.
DelGaudio JM, Evans SH, Sobol SE, Parikh SL. intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting. Am J Otolaryngol. 2010;31(1):25–8. Retrospective review of patients with intracranial
complications of sinusitis demonstrating the need for combined neurosurgical and rhinological surgical approach.
Szyfter W, Kruk-Zahajewska A, Bartochowska A, Borucki L. Intracranial complications from sinusitis. Otolaryngol Pol. 2015;69(3):6–14.

3. Anatomy

4. Epidemiology
 Rare
 2–7:1 male to female ratio
 can present at any age, but most commonly present in the second and
third decades of life
Goldberg AN, Oroszlan G, Anderson TD. Complications of frontal sinusitis and their management. Otolaryngol Clin N Am. 2001;34(1):211–25.
Nicoli TK, Oinas M, Neimela M,Makitie AA, Atula T. Intracranial Suppurative complications of sinusitis. Scand J Surg. 2016;105(4): 254–62.
DelGaudio JM, Evans SH, Sobol SE, Parikh SL. intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting. Am J Otolaryngol. 2010;31(1):25–8. Retrospective review of patients with intracranial
complications of sinusitis demonstrating the need for combined neurosurgical and rhinological surgical approach.

5. Etiopathogenesis
Etiology
 Streptococcus and Staphylococcus
 Anaerobes
 Fungal
Pathogenesis
 Retrograde spread through valveless diploic veins via propagation of the
thrombus or release of septic emboli. These veins drain the paranasal sinus
mucosa and connect to the dural venous sinuses
 Direct extension of disease through bone via congenital or traumatic defects,
sinus wall erosion or dehiscence, or existing foramina
Patel AP, Masterson L, Deutsch CJ, Scoffings DJ, Fish BM. Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol. 2015;79(6):868–73. Retrospective review of current outcomes in
children with sinogenic intracranial abscesses.
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Brook I, Friedman EM, RodriquezWJ, Controni G. Complications of sinusitis in children. Pediatrics. 1980;66(4):568–72.
Stankiewicz JA, Newell DJ, Park AH. Complications of inflammatory diseases of the sinuses. Otolaryngol Clin N Am. 1993;26(3): 639–55.

6. Ziegler, A., Patadia, M. & Stankiewicz, J. Curr Neurol Neurosci Rep (2018) 18: 5.

7. Fungal Sinusitis
 Fungal ball, allergic fungal sinusitis, acute invasive fungal sinusitis, and
chronic invasive fungal sinusitis
 The most common causative organisms are Aspergillus, Mucormycosis
(previously called zygomycosis), and Rhizopus
 Treatment consists of aggressive surgical debridement, intravenous
anti-fungal therapy, and correcting the underlying
immunocompromised state if able
 High mortality
Patadia MO, Welch KC. Role of immunotherapy in allergic fungal rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg. 2015;23(1): 21–8.
Ghegan MD, Lee FS, Schlosser RG. Incidence of skull base and orbital erosion in allergic fungal rhinosinusitis (AFRS) and non-AFRS. Otolaryngol Head Neck Surg. 006;134(4):592–5.
Liu JK, Schaefer SD, Muscatello AL, Couldwell WT. Neurosurgical implications of allergic fungal sinusitis. J Neurosurg. 2004;100(5):883–90.
Marfani MS, Jawaid MA, Shaikh SM, Thaheem K. Allergic fungal rhinosinusitis with skull base and orbital erosion. J Laryngal Otol. 2010;124(2):161–5.
Hedges TR, Leung LS. Parasellar and orbital apex syndrome caused by aspergillosis. Neurology. 1976;26(2):117–20. Shamim MS, Siddiqui AA, Enam SA, Shah AA, Jooma R, Anwar S. Craniocerebral aspergillosis in immunocompetent
hosts: surgical perspective. Neurol India. 2007;55(3):274–81.

8. Prognosis
 30 % patients have longterm sequelae
 Epilepsy, permanent visual changes, and focal paresis
 The best chance to improve outcomes is through early diagnosis and
treatment of these potential neurologic complications via a
multidisciplinary approach
 Life threatening, but mortality decreasing in antibiotic era
Ziegler, A., Patadia, M. & Stankiewicz, J. Curr Neurol Neurosci Rep (2018) 18: 5.

9. Summary
 Rare
 High morbidity and mortality
 Sphenoid sinus
 Bacteria and fungal
 Orbital involvement
 Medical treatment + Surgical
 Multidisciplinary approach