Intracranial abscess and empyema from ENT origin

Intracranial abscess and empyemas from ENT infection are rare. The aim of our study was to recall the treatment and therapeutic results. It was a retrospective study from 1995 to 2006 concerning. 23 patients who had brain abscesses secondary to an ENT infection. The infections origin was otological in 56% of cases, sinusal in 44%. Bacterias were identified in 40% of cases. All patients benefited a medical treatment to basis of at least 2 antibiotics a long length going from 20 days to 3 less by intravenous way. Nine patients benefited neurosurgery with an ENT treatment surgical. Nine patients had alone neurosurgery and 5 cases had an ENT surgery alone. The treatment consists in excision or single punction of the abscess. 72% are alive and well. We have no dead. The classical intracranial hypertension associated to high fever is usually truncated. The diagnosis is more precocious thanks to the progress of the medical imagery. Multibacterial infections are frequent. Treatment is medical and surgical. Recovery requires a specific surgical treatment of the ENT infection in more than 60% of cases. An adapted treatment permits a recovery without after effects in at least the half of cases

Microsurgical direct transnasal approach to pituitary adenomas assisted by endoscope: description and advantages

The sub-labial transsphenoidal approach is frequently used in pituitary surgery. The direct transnasal transsphenoidal route is a minimally invasive technique. The main difficulty associated in this approach is its tendency to take an oblique trajectory, so it can benefit from the combination of use of the microscope and the endoscope. We have analysed the data of the first 10 patients operated on through the direct transnasal route for pituitary adenomas in our institution. The operating procedure was done in 2 steps: 1. Direct transnasal approach to the sphenoid sinus to reach the floor of the sella turcica with the endoscope for trajectory guidance 2. Effraction of the sella turcica floor, opening of the dura mater and adenoma excision under the operating microscope We have analysed the feasibility, endoscopic benefits and effectiveness of this procedure. Ten patients were operated having pituitary adenomas between March 2003 and September 2004. The endoscope is introduced through the right nostril to reach the sphenoid sinus. We did not resort to fluoroscopy. Adenoma exeresis was made under microscope and was complete in 8 cases. Complications such as transient CSF leakage and epistaxis were observed in one case. The initial use of the endoscope permits rapid and direct access to the sella turcica. Relay by the operating microscope allows ease of tumoural exeresis. Moreover, this approach avoids the traditional drawbacks of the sub-labial route