Management of Pediatric Skull Base AbscessesTyler G. Kimbrough MD PhD,1,2 Abby C. Meyer MD,1,2

Marsha Finkelstein MS,1 James D. Sidman MD1,2

1Childrens Hospitals and Clinics of Minnesota-Minneapolis, Minnesota2University of Minnesota Department of Otolaryngology-Head and Neck Surgery, Minneapolis, Minnesota

Results:Over the study period 179 patients were admitted for management of deep neck space infections. Of these, 9 (6%) were localized to the skull base by CT scan. 6 of the 9 met radiographic criteria for an abscess, the remaining 3 were designated edema or phlegmon. Initial treatment consisted of IV antibiotics in all cases. 70% resolved with medical management alone. 3 patients failed to resolve following 48 hrs of IV antibiotics and were taken to the operating room for abscess drainage which was unsuccessful in all cases. Repeat CT after an additional 48 hours of medical therapy indicated persistent abscess in 2 of the 3 operative cases. Repeat drainage was unsuccessful in both. In all cases there was complete resolution of infection with antibiotics. Conclusions: Skull base abscesses in children can be effectively managed in most cases by IV antibiotics alone. Surgical drainage is difficult and often unsuccessful and therefore poses unnecessary risk to the patient. Image guided abscess drainage, while not available to us, may also be an effective management strategy.

Figure 2: CT scan of abscess located at the skull base. Representative CT images from two pediatric patients with abscesses located near the skull base. Spiral acquisition was performed through the neck at 0.5 millimeter resolution following administration of intravenous Optiray 320 contrast . Axial (A,D), Coronal (B,E), and Sagital (C,F) images are shown. Patient 01 (A-C); Patient 02 (D-F). In both patients a small area of hypoatenuation with rim enhancement can be visualized posterior to the left paraphayngeal space , adjacent to the skull base. Red arrows indicate location of abscess.

A CB

D FE

Table 2: Management of Children with Skull Base Abscesses from 2000-2007 (N=9).

Introduction: Otolaryngologists are routinely involved in the management of deep neck space infections in the pediatric population. While the gold standard for treatment of deep neck space abscesses has been I/D, recent reports indicate that IV antibiotics alone can lead to resolution of infection in the majority of cases. In this report we describe our experience with management of pediatric neck abscesses located at the skull base.

Objectives: To describe the presentation and management of pediatric deep neck space infections located at the skull base.

Methods: Design: Retrospective review. Setting: Tertiary children’s hospital. The study population comprised pediatric patients admitted to the hospital for management of deep neck space infections between 2000 and 2007.

Main Outcome Measure: Resolution of abscess.

Table 1: Characteristics of Children with Skull Base Abscess from 2000-2007 (N=9)

Figure 1: Pediatric skull base anatomy