OBJECTIVE: Sinusitis is a rare cause of intracranial infection in children. 
While intracranial complications of sinusitis are rare, the morbidity and 
mortality remain high. Subdural empyema is recognized as the most common 
sinogenic intracranial complication. We undertook a review of our cases of 
subdural empyema and other intracranial complications of sinusitis over the past 
8 years at a busy inner city hospital. Our intent was to identify factors that 
may predispose children to these serious complications.
METHODS: A retrospective chart review was conducted using ICD-9 codes to 
identify pediatric patients treated for complications of sinusitis at University 
Hospital (UH) from 1996 to 2004. Only patients age 18 or younger at the time of 
admission were included in this study. The following data were collected from 
hospital medical records: age, gender, past medical and social history, 
presenting symptoms, history of present illness, microbiology, surgical and 
medical intervention, and outcome.
RESULTS: Twelve patients were identified that fit the criteria for this study. 
The mean age of these patients was 14.1 years, and 10 of our 12 patients were 
male (83.3%). The most common presenting complaints were fever, headache, 
altered mental status, orbital cellulitis, nasal symptoms, nausea and vomiting, 
and photophobia. In the week prior to admission for intracranial complications, 
nine patients were seen by a physician: five patients were seen in the ER and 
four by a primary care physician. Subdural empyema was the most commonly 
observed intracranial complication in this series. Microaerophilic and anaerobic 
organisms were most commonly identified in this series. Most sinus procedures 
consisted of endoscopic ethmoid and maxillary sinus drainage. There was a 
long-term morbidity rate of 16% and a mortality rate of 8%.
CONCLUSIONS: Three conclusions may be drawn from this study. First, the 
morbidity and mortality of intracranial complications of sinusitis remain high 
in the pediatric inner-city population despite adequate access to medical care. 
Second, subdural empyema appears to arise in the setting of subacute rather than 
acute frontal sinusitis. Lastly, there may be an under-diagnosis and delay in 
treatment of patients with frontal sinusitis, resulting in subsequent 
intracranial complications.