Endoscopic Transnasal Drainage of Frontal Epidural Abscesses

Background: Although rare, sinogenic intracranial epidural frontal abscesses remain a serious and potentially life-threatening complication of sinusitis. Traditional therapy involves a combination of intravenous antibiotics, sinus surgery, and neurosurgical drainage through an external approach. Objective: In this report, we present a technique in which a purely endoscopic transnasal approach was used to treat both the sinusitis and the intracranial abscess. Four cases are discussed illustrating the technique and its outcomes. Methods: In all cases, endoscopic sinus surgery was performed to treat underlying sinus disease. Next, under image guidance, an endoscopic, intranasal opening through the skull base was performed for intracranial access and abscess drainage. Results: Our patients tolerated this procedure well and fully recovered with resolution of all presenting neurologic features. Conclusion: This approach may offer a safe and effective alternative to frontal craniotomy for selected cases and can result in lower postoperative morbidity than traditional approaches.