Transethmoidal Drainage of Frontal Brain Abscesses

Background: The frontal lobe is the second most common location for brain abscess after the temporal lobe. Since the advent of computed tomography and magnetic resonance imaging scanning, diagnosis has become easier, but the prognosis of brain abscess is still poor. Treatment is based on antimicrobial therapy and neurosurgical evacuation, but controversy still remains as to the merits place of each. Methods: This study describes 2 cases of patients with frontal abscesses treated by endonasal transethmoidal sinus surgery (ESS) and reviews the literature on this topic. Results: Follow-up revealed no cerebrospinal fluid leak in both patients, complete abscess drainage in one patient, and incomplete drainage in the other. Conclusions: ESS drainage of frontal abscesses is feasible in intracerebral and epidural abscesses if they have a thick shell and are in contact with the skull base. The procedure is minimally invasive and relatively simple. It allows for rapid microbial identification and an effective drainage.