Endoscopic Transethmoid Drainage of a Brain Abscess

Background: The frontal lobe is the second most common location for brain abscesses after the temporal lobe. Although rare in developed countries, this is a serious, life-threatening emergency. The morbidity and mortality has decreased because of advances in diagnostic modalities, antibiotic regimens, and earlier surgical interventions. The treatment is difficult and relies on a combination of neurosurgical drainage and intravenous antibiotic therapy.

Methods: We report a case of an intracerebral frontal abscess treated endoscopically through a transnasal transethmoid window.

Case: A 59-year-old woman was referred to our neurosurgery department with a history of collapse, GCS 14/15, and pyrexia. An urgent MRI scan showed a 3×2-cm abscess in continuity with the left anterior skull base. Intravenous antibiotic therapy was initiated, but after 8 hours there was deterioration in her neurological status. A decision was made to drain the abscess by a transnasal transethmoid route.

Results: The abscess was successfully drained using intraoperative image guidance and allowed for microbial analysis. The skull base defect was repaired using an ipsilateral pedicled inferior turbinate mucosal flap. The immediate postoperative course was uncomplicated, without CSF leak or meningitis, and the patient made a complete recovery to GCS 15/15. Follow-up with an MRI scan at 6 months showed no evidence of abscess recurrence.

Conclusion: The decision to perform surgery in this situation is usually multidisciplinary. This case highlights the advantages of the transnasal transethmoid route, allowing for microbial identification and definitive drainage of the abscess without intracerebral penetration.