J Korean Neurosurg Soc.  2014 Mar;55(3):178-180. 10.3340/jkns.2014.55.3.178.

Management of Otogenic Brain Abscess Using the Transmastoid Approach

• Choi J
• Choi JI
• Kim SD

• KMID: 2191088
• DOI: http://doi.org/10.3340/jkns.2014.55.3.178

Abstract

Despite significant advances in the treatment of all forms of chronic otitis media (COM), complications still can and do occur, with intracranial complications representing the most life-threatening cases, often requiring immediate therapeutic intervention. Herein, we present a rare case of rapidly progressing facial paralysis with concomitant severe headache and ipsilateral hearing loss secondary to an otogenic brain abscess, treated with the transmastoid approach, drainage, and facial nerve decompression.

Keyword

Otogenic brain abscess; Transmastoid approach

MeSH Terms

Brain Abscess*
Decompression
Drainage
Facial Nerve
Facial Paralysis
Headache
Hearing Loss
Otitis Media

Figure

• 

  Fig. 1 Total perforation of the tympanic membrane, edematous mucosa, and profound discharge documented on endoscopic examination of the left ear.

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  Fig. 2 A : The dehiscence of the mastoid segment of the facial nerve was identified during the 1st operation (black arrow : mastoid segment of the facial nerve, white arrow : lateral semicircular canal, asterisk : lower posterior wall of thee external auditory canal). B : An 18-gauge needle was advanced into the abscess via the transmastoid approach, yielding 12 mL of pus.

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  Fig. 3 The 2.6×3.1×3.2-cm-sized, well circumscribed abscess surrounded by peripheral rim enhancement on T1-weighted MRI (A : axial view, B : coronal view).

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  Fig. 4 After 8 weeks of parenteral postoperative antibiotic therapy, the abscess was no longer visible on MRI (A : axial view, B : coronal view).

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