Endoscopic transplanum drainage of epidural abscess in a pediatric patient.

Although complications of acute rhinosinusitis have become less frequent with appropriate antibiotic use, intracranial manifestations remain a feared problem that occasionally requires emergent neurosurgical management.[[1]] These manifestations, occurring in 35% to 4% of all patients admitted for sinusitis and more commonly in pediatric patients, include meningitis, intracranial abscess, dural venous sinus thrombosis, and cerebral infarction.[[2], [4]] In sinusitis complicated by abscess formation above the planum sphenoidale, the traditional surgical approach is transbasal craniotomy. Here, we describe the endoscopic transnasal, transsphenoidal, transplanum drainage of an epidural abscess located above the planum sphenoidale in a young child with poorly pneumatized sphenoid sinuses. It has become a safe and effective alternative approach to multiple challenging pediatric skull base pathologies.[[13]] Because the epidural abscess pushes the dura mater away from the planum bone, entering the cranial vault endoscopically without violating the dura is relatively straightforward. We have previously demonstrated the endoscopic transsphenoidal approach to be safe in pediatric patients with all patterns of sphenoid pneumatization for craniopharyngioma resection.[18] In this case presentation, we further demonstrate this technique as a favorable approach for drainage of anterior skull base epidural abscesses in young children with poorly pneumatized sphenoids. [Extracted from the article]