Intracranial complications of sinogenic and otogenic infections in children: single center study in a global increasing trend

BACKGROUND: Recent studies have documented a rising incidence of intracranial complications of sinusitis and otitis (ICSO) in the post-COVID-19 era, particularly in pediatric patients. The aim of this study is to analyze this trend in our institution and compare it with recent literature, with a specific focus on decompressive craniectomy as critical part of the surgical management. METHODS: We retrospectively reviewed all patients under 18 years of age admitted to Bambino Gesù Children's Hospital with a discharge diagnosis of ICSO, between January 2017 and December 2024. We analyzed patients' demographic data, pathogen characteristics, type of primary infection and intracranial complications, and signs and symptoms at presentation. Management of the infection and cerebral venous sinus thrombosis (CVST) rate were also reported, along with clinical and radiological outcomes. RESULTS: A total of 26 patients were included with an estimated increase of 1.07 patients per year (β=1.07, 95% CI [0.23, 1.91], P=0.018). 3 patients were managed exclusively with antibiotic therapy, 2 underwent sinus endoscopic surgical treatment, 11 underwent neurosurgical intervention, and 10 required a combined approach. Six patients underwent decompressive craniectomy. Venous sinus thrombosis was identified in 10 patients. Overall, 19 patients had a clinical complete recovery, while 5 presented residual deficits at follow-up. 2 patients had a fatal progression of the infection. CONCLUSIONS: This single-center study highlights a significant increase in ICSO in the post-COVID-19 era in the pediatric population, with a high proportion of venous sinus thrombosis (40%) and decompressive craniectomy (29%). High vigilance for ICSO in children, particularly in the context of evolving post-pandemic infectious disease patterns is recommended.