Endoscopic endonasal surgery for intracranial rhinogenic complications. Analysis of two clinical cases

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Abstract

Rhinogenic intracranial complications, such as brain abscess and thrombosis of the veins and sinuses of the brain, are still a formidable, life-threatening pathology, often resulting in death, despite the widespread development of antibiotic therapy and adherence of patients to the treatment. Often the cause of the development of intracranial complications is the exacerbation of a chronic inflammatory process in the paranasal sinuses, while acute ENT pathology of the sinuses leads to the development of rhinogenic complications only in a small percentage of cases. Unfortunately, the high development of radiation and laboratory diagnostics does not always allow diagnosing these conditions in time and providing adequate surgical care. In childhood and adolescence, it is important to perform a timely complete and at the same time minimally invasive, non-disabling, surgical intervention. An analysis of foreign literature in recent years shows that neurosurgical operations in various volumes (from trepanopuncture of the brain to craniotomy) occur in the vast majority of cases of treatment of rhinogenic intracranial complications. The article presents two clinical cases of patients with intracranial complications successfully treated in the Department of Otorhinolaryngology of St. Petersburg State Pediatric Medical University without a highly traumatic neurosurgical operation. The combination of endonasal endoscopic surgery and massive adequate conservative therapy (antibiotic therapy in combination with the use of anticoagulants for sinus thrombosis) allows the patient to recover without resorting to neurosurgical intervention.

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About the authors

Vyacheslav A. Verezgov

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: verezgov@gmail.com

MD, PhD, otorhinolaryngologist

Russian Federation, Saint Petersburg

Dmitry V. Breusenko

St. Petersburg State Pediatric Medical University

Email: lor-gpma@mail.ru

MD, PhD, Head of the Department of Otorhinolaryngology

Russian Federation, Saint Petersburg

Pavel V. Pavlov

St. Petersburg State Pediatric Medical University

Email: pvpavlov@mail.ru
ORCID iD: 0000-0002-4626-201X

MD, PhD, Dr. Med. Sci., Associate Professor, Head of the Department of Otorhinolaryngology

Russian Federation, Saint Petersburg

Maria L. Zakharova

St. Petersburg State Pediatric Medical University

Email: dr.essina@mail.ru
ORCID iD: 0000-0001-6410-3533

MD, PhD, Dr. Med. Sci., Associate Professor of the Department of Otorhinolaryngology

Russian Federation, Saint Petersburg

Alexandra S. Snytkina

St. Petersburg State Pediatric Medical University

Email: snytkina.aleksandra@mail.ru
ORCID iD: 0000-0002-2282-8584

PhD, clinical intern at the Department of Otorhinolaryngology

Russian Federation, Saint Petersburg

Oksana K. Gorkina

St. Petersburg State Pediatric Medical University

Email: gorkina-ok@yandex.ru
ORCID iD: 0000-0002-2527-9023

PhD, Assistant of Professor of the Department of Otorhinolaryngology

Russian Federation, Saint Petersburg

Valery V. Dmitrenko

St. Petersburg State Pediatric Medical University

Email: dmitrenko1411@mail.ru
ORCID iD: 0000-0003-2766-6577

otorhinolaryngologist

Russian Federation, Saint Petersburg

Yulia A. Kuryanova

St. Petersburg State Pediatric Medical University

Email: Julia_ku@mail.ru
ORCID iD: 0000-0003-3843-0201

otorhinolaryngologist

Russian Federation, Saint Petersburg

Olga E. Kukushkina

St. Petersburg State Pediatric Medical University

Email: o.lka@mail.ru
ORCID iD: 0000-0001-5351-3764

otorhinolaryngologist

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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1. Fig. 1. Multispiral computed tomography of the paranasal sinuses and brain from 04.06.2021: coronal (а) and axial (b) projections in the protocol of the skull, subtotal shading of the left frontal sinus, no bone destruction; axial (c) and sagittal (d) projections in the brain mode, epidural empyema of the left frontal area of the brain; coronary (е) and axial (f) projections in brain mode with contrast enhancement. Epidural empyema of the left frontal region of the brain. The capsule is clearly visible

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2. Fig. 2. Magnetic resonance imaging of the brain from 16.06.2021; a – sagittal projection in T2 mode. Inflammatory changes in the membranes in the left frontal region are traced. Picture consistent with subdural empyema; b – axial projection in T2 mode. Decreased pneumatization of the left maxillary sinus, parietal edema; c – axial projection in T2 mode. Decreased pneumatization of cells of the ethmoid labyrinth; d – axial projection in T2 mode. Inflammatory changes in the membranes in the left frontal region, subdural empyema

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3. Fig. 3. Multispiral computed tomography of the paranasal sinuses and brain from 06.16.2021: a – axial projection in brain mode. There is an increase in pneumatization of the frontal sinus; b – coronary projection in brain mode. The pneumatization of the cells of the ethmoid labyrinth on the left was restored, the lesion of the left frontal lobe remains; c – coronary projection in brain mode. Restored pneumatization of the left maxillary sinus; d – sagittal projection in brain mode. Improvement of pneumatization of the left frontal sinus; e – axial projection in skull mode. Improvement of pneumatization of the left frontal sinus; f – coronal projection in skull mode. Restored pneumatization of the left maxillary sinus; g – coronal projection in skull mode. Restored pneumatization of the left maxillary sinus, parietal edema; h – sagittal projection in skull mode. Improvement of pneumatization of cells of the ethmoid labyrinth, frontal sinus

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4. Fig. 4. Computed tomography of the paranasal sinuses and brain from 08.11.21: axial projection in skull mode. Total shading of the right half of the sphenoid sinus on the right, fluid level in the left maxillary sinus

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5. Fig. 5. Magnetic resonance imaging of the head from 10.11.2021: right-sided sphenoiditis, thrombosis of the cavernous sinus on the left. Left: coronal projection in T2 mode. Total shading of the right half of the sphenoid sinus, narrowing of the cavernous sinus on the left; right: axial projection in T2 mode. Signs of thrombosis of the cavernous sinus on the left

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6. Fig. 6. Signs of cavernous sinus thrombosis on magnetic resonance imaging of the brain. 1 — Venous congestion in the retrobulbar tissue; 2 — narrowing of the lumen of the siphon of the internal carotid artery on the left; 3 — structure heterogeneity

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7. Fig. 7. Magnetic resonance imaging of the head from 24.11.2021: a – axial projection in T1 mode. Pneumatization of the sphenoid sinus is almost completely restored; b – coronal projection in T1 mode. Siphons of the internal carotid arteries have the same lumen; c – axial projection in T2 mode. Improvement of pneumatization of the right main sinus; d – axial projection in T2 mode. The absence of exophthalmos of the left eye, edema of the retrobulbar tissue on the left was stopped. Increase in the lumen of the siphon of the internal carotid artery on the left; e – coronal projection in T2 mode. Pneumatization of the maxillary sinus on the left was completely restored

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Copyright (c) 2022 Verezgov V.A., Breusenko D.V., Pavlov P.V., Zakharova M.L., Snytkina A.S., Gorkina O.K., Dmitrenko V.V., Kuryanova Y.A., Kukushkina O.E.

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