Neurosurg Focus. 2025 Nov 1;59(5):E6. doi: 10.3171/2025.8.FOCUS25679.
ABSTRACT
OBJECTIVE: Intracranial empyemas (IEs) are rare but severe complications of ear, nose, and throat (ENT) infections, defined as purulent collections in the normally virtual meningeal spaces. IEs can be classified as sinogenic (S-IE) or otogenic (O-IE), according to the initial infection. These life-threatening complications can entail long-term neurological disabilities. Few studies have described their characteristics, and cohorts are usually small and heterogeneous. In the Greater Paris area, all cases of pediatric IE are referred to the authors’ center. The aim of this study was to describe the characteristics of IE and their treatment and risk factors for repeated surgery and neurological disabilities.
METHODS: This single-center, retrospective observational cohort study included all consecutive cases of IE admitted to the authors’ institution between January 2016 and January 2025.
RESULTS: A total of 248 patients with IE were included: 115 with S-IE and 133 with O-IE. The mean age was 6.9 ± 5.2 years. An increase in the incidence of IEs was observed over the final years of the study. Two clinical presentations were distinguished. O-IEs were observed in younger children (mean 40 ± 37 months vs 133 ± 44 months for S-IE). O-IEs were almost exclusively extradural (96%), whereas around half of S-IEs had subdural involvement (51%). S-IEs were associated with more neurological symptoms. All patients underwent surgery. Overall, 95% of patients with O-IEs and 85% of those with S-IEs underwent ENT surgery. Neurosurgery was necessary for 7% (9/133) of O-IEs and 60% (69/115) of S-IEs. Bacteriological samples were obtained, and identification was achieved in 86% (culture or polymerase chain reaction techniques). For O-IE, Fusobacterium necrophorum (47%) was the most frequent, whereas in S-IE cases, the Streptococcus milleri group (52%) was predominant. Cerebral venous thrombosis (CVT) was the most frequent complication, in 55% of O-IE cases and 21% of S-IE cases (p < 0.0001). There were no deaths in this cohort. Neurological disabilities were observed in 17% of patients, with a higher rate for those with S-IEs (27%) than those with O-IEs (8%) (p < 0.0001). Subdural empyema and parietal and interhemispheric locations were identified risk factors for neurological sequelae. Repeat surgery was necessary for 30% of patients with S-IEs and 11% of patients with O-IEs (p < 0.0001). The observed risk factors were residual IE at control MRI and the association of CVT.
CONCLUSIONS: This study describes the largest pediatric IE cohort to date. An increase in incidence has been observed since 2021. The favorable results of this cohort suggest that the authors’ multidisciplinary standardized treatment protocol provides successful treatment to most patients with IE.
PMID:41175410 | DOI:10.3171/2025.8.FOCUS25679
