CNS complications of frontal sinus disease

In the antibiotic era, intracranial complications of sinusitis have become less commonplace, but nevertheless continue to occur and be associated with significant morbidity and mortality. The frontal sinus is the most common source of intracranial complications of sinusitis, followed by the ethmoid, sphenoid, and maxillary sinuses [1]. Spread of infection from the frontal sinus to the intracranial space typically occurs by hematogenous spread through a communicating venous system. The small, valveless diploic veins (veins of Breschet) that extend through the posterior table of the sinus directly contribute to the venous plexi of the dura and periosteum [26]. Bacterial thrombi can travel throughout this network and seed intracranial sites remote from the frontal sinus, leading to meningitis, epidural or intracerebral abscesses, or subdural empyema. In some instances, a retrograde thrombophlebitis can develop and cause the further complications of cavernous or superior sagittal sinus thrombosis. Such life-threatening conditions must be recognized promptly and treated aggressively.