Sinogenic Intracranial Suppuration in Children: Systematic Review and Meta-analysis.

Objective: To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children.

Data Sources: A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov).

Review Methods: Studies in children (age <18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death <90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes.

Results: A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%; = 0, > .99), 21.3% (95% CI, 15.3%-27.3%; = 75.2%, < .001), and 37.3% (95% CI, 29.5%-45%; = 71.2%, < .001), respectively, with no significant differences found across the study period. The pooled estimate for ESS was 58.4% (95% CI, 44.2%-72.6%; = 97.1%, < .001) with a significantly increasing trend in its use in the more recent years. ESS was not associated with improved mortality, reduced need for revision surgery, or neurologic disability.

Conclusion: The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.