Diagnosis at first sight
Recurrent frontal tumour in a patient with repeated craniotomies
Tumoración frontal recidivante en paciente con craneotomías de repetición
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Vizcaya, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tumoración frontal recidivante en paciente con craneotomías de repetición" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 699 "Ancho" => 900 "Tamanyo" => 71964 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right frontal region with fluctuating swelling.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">32-Year-old male, intranasal drug user, who was involved in a road traffic accident when he was 18 years of age, with comminuted right frontal and supraorbital bone fractures and subsequent recurrent CSF leak (fistula), associated with recurrent meningitis caused by <span class="elsevierStyleItalic">H. influenzae</span> and <span class="elsevierStyleItalic">S. pneumoniae</span>, which required up to 3 prior surgeries. He was admitted in April 2011 due to pneumococcal (<span class="elsevierStyleItalic">S. pneumoniae</span>) meningitis associated with fluctuating swelling of the forehead and right frontal epidural abscess (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A right frontal craniotomy and sinus drainage was performed, obtaining cultures positive for <span class="elsevierStyleItalic">S pneumoniae</span>; after 6 weeks of treatment with intravenous ceftriaxone and an asymptomatic period with no recurrences, a right frontal cranioplasty (CustomBone<span class="elsevierStyleSup">®</span>) was implanted in September 2012.</p><p id="par0015" class="elsevierStylePara elsevierViewall">After one year symptom-free, the patient was readmitted in November 2013 with recurrent pneumococcal meningitis and with an underlying previous epidural abscess to the cranioplasty that had to be removed, debridement of the right frontal sinus and intravenous treatment with ceftriaxone followed by oral levofloxacin. Due to intolerance, the patient switched to clindamycin, which he received until he completed 6 months of treatment (June 2014).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinical course</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was readmitted in October 2014 due to recurrence of fluctuating swelling with spontaneous supranasal suppuration and cultures positive for <span class="elsevierStyleItalic">coagulase-negative Staphylococci</span>. After administering vancomycin<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>ceftriaxone, and despite the brain MRI not showing obvious intracranial collections (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), another frontal craniotomy, drainage and debridement of the left frontal sinus, supranasal sinus and residual right supraorbital sinus sealed with wax were performed, and vancomycin and gentamycin were administered. The intraoperative cultures were negative and the universal 16S PCR undetectable, so intravenous treatment was completed for 6 weeks with IV teicoplanin 600<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h and ceftriaxone 2<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Final comment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Suppurative osteomyelitis of the frontal bone, also known as Pott's Puffy Tumour, is a rare and little-known condition that is seldom reported in the medical literature. It is characterised by fluctuating swelling of the forehead secondary to a subperiosteal abscess caused by frontal bone osteomyelitis. It is most commonly seen in children and adolescents in whom the most widespread predisposing factor is acute or chronic frontal sinusitis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> It is much less common in adults, however, and the main risk factors include frontal bone trauma, prior craniotomy or cranioplasty, mastoiditis, nasal drug abuse, tooth infection and ethmoid sinusitis.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The pathogenesis of this condition is closely related to the unique anatomy of the sinuses and the ease of propagation through the mucosal venous drainage of the frontal sinus towards the diploë. The solutions of continuity in the sinus wall secondary to the risk factors described above facilitate progression of the infection. The clinical picture varies depending on the spread of the infection, and it may manifest as swelling of the frontal region without intracranial spread if it progresses towards the external table of the frontal bone, as an epidural abscess if it progresses towards the internal table or as orbital cellulitis if it spreads towards the supraorbital region.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is diagnosed on the basis of clinical and radiological findings. Typical symptoms in adults include fever, purulent rhinorrhoea, frontal or orbital cellulitis, fluctuating swelling or frontal fistula, as well as neurological symptoms such as meningitis or frontal focal symptoms.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The CT scan is the gold standard for frontal bone osteomyelitis diagnosis, while MRI is effective at identifying intracranial complications. Labelled leucocyte scintigraphy may be useful in monitoring treatment response.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The bacteria involved in the pathogenesis of the condition are mostly found in the saprophytic flora of the sinuses and lead to infection by anaerobic <span class="elsevierStyleItalic">S. aureus and Streptococcus</span> sp., Gram-negative bacteria and fungi.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment involves a combined medical-surgical approach: early broad-spectrum antibiotic treatment and the surgical drainage of intracranial collections (external or endoscopic) depending on the location and extent of the complications.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Prognosis is variable and is determined by potential neurological sequelae and the high probability of recurrence, associated with significant morbidity owing to the need for multiple surgical procedures as shown in the case presented above.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,8</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Funding</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors declare that they have not received funding of any kind to complete this study.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical course" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Final comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 5 => array:2 [ "identificador" => "xack277737" "titulo" => "Acknowledgements" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Corcóstegui Cortina T, Guío Carrión L, Aurrekoetxea Obieta J, Montejo Baranda JM. Tumoración frontal recidivante en paciente con craneotomías de repetición. Enferm Infecc Microbiol Clin. 2017;35:262–263.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 699 "Ancho" => 900 "Tamanyo" => 71964 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Right frontal region with fluctuating swelling.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 851 "Ancho" => 800 "Tamanyo" => 80225 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Brain MRI with gadolinium, sagittal plane.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 900 "Ancho" => 900 "Tamanyo" => 69692 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Brain MRI with gadolinium, coronal plane (October 2014).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor inflamatorio de Pott: una complicación infrecuente de la sinusitis frontal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "D. Aínsa" 1 => "S. Pons" 2 => "A. Muñoz" 3 => "M.I. Vega" 4 => "M.C.L. Otero" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2014" "volumen" => "80" "paginaInicial" => "317" "paginaFinal" => "320" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0050" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of adult Pott's puffy tumor: our five cases and 27 literature cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Akiyama" 1 => "M. Karaki" 2 => "N. Mori" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/lary.23490" "Revista" => array:6 [ "tituloSerie" => "Laryngoscope" "fecha" => "2012" "volumen" => "122" "paginaInicial" => "2382" "paginaFinal" => "2388" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22865613" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0055" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Neurosurgical implications of Pott's puffy tumor in children and adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Salomao" 1 => "T.P. Cervante" 2 => "A.R. Bellas" 3 => "M.C. Boechat" 4 => "S.M. Pone" 5 => "M.V. de Pone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00381-014-2480-x" "Revista" => array:6 [ "tituloSerie" => "Childs Nerv Syst" "fecha" => "2014" "volumen" => "30" "paginaInicial" => "1527" "paginaFinal" => "1534" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24996535" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0060" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frontal sinusitis causing epidural abscess and puffy tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Nicoli" 1 => "A. Makitie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMicm1307740" "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2014" "volumen" => "370" "paginaInicial" => "e18" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24620894" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0065" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Osteomyelitis of the frontal bone (Pott's puffy tumor). A report of 5 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S. Ibarra" 1 => "K. Aguirrebengoa" 2 => "I. Pomposo" 3 => "E. Bereciartua" 4 => "M. Montejo" 5 => "P. González de Zarate" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "1999" "volumen" => "17" "paginaInicial" => "489" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10650643" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0070" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Pott's puffy tumor: a dangerous sign for intracranial complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Ketenci" 1 => "Y. Unlu" 2 => "B. Tecer" 3 => "A. Vural" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00405-011-1660-5" "Revista" => array:6 [ "tituloSerie" => "Eur Arch Otorhinolaryngol" "fecha" => "2011" "volumen" => "268" "paginaInicial" => "1755" "paginaFinal" => "1763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21660452" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0075" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic endonasal treatment of a Pott's puffy tumor" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Jung" 1 => "H.C. Lee" 2 => "I.H. Park" 3 => "H.M. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3342/ceo.2012.5.2.112" "Revista" => array:6 [ "tituloSerie" => "Clin Exp Otorhinolaryngol" "fecha" => "2012" "volumen" => "5" "paginaInicial" => "112" "paginaFinal" => "115" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22737293" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0080" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The Pott puffy tumor revisited: neurosurgical implications of this unforgotten entity. Case report and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Kombogiorgas" 1 => "G.A. Solanki" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "2006" "volumen" => "105" "numero" => "Suppl. 2" "paginaInicial" => "S143" "paginaFinal" => "S149" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack277737" "titulo" => "Acknowledgements" "texto" => "<p id="par0070" class="elsevierStylePara elsevierViewall">We would like to thank the clinicians involved in the case listed as co-authors, as well as all the other clinicians who helped to treat this patient during his multiple readmissions.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000004/v1_201704140226/S2529993X17300813/v1_201704140226/en/main.assets" "Apartado" => array:4 [ "identificador" => "65382" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Diagnostic at first sight" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000004/v1_201704140226/S2529993X17300813/v1_201704140226/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17300813?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 19 | 6 | 25 |
| 2024 September | 10 | 5 | 15 |
| 2024 August | 21 | 13 | 34 |
| 2024 July | 27 | 9 | 36 |
| 2024 June | 13 | 1 | 14 |
| 2024 May | 11 | 5 | 16 |
| 2024 April | 12 | 3 | 15 |
| 2024 March | 33 | 4 | 37 |
| 2024 February | 25 | 2 | 27 |
| 2024 January | 29 | 3 | 32 |
| 2023 December | 31 | 7 | 38 |
| 2023 November | 27 | 2 | 29 |
| 2023 October | 29 | 5 | 34 |
| 2023 September | 19 | 2 | 21 |
| 2023 August | 13 | 1 | 14 |
| 2023 July | 16 | 4 | 20 |
| 2023 June | 19 | 1 | 20 |
| 2023 May | 37 | 1 | 38 |
| 2023 April | 42 | 6 | 48 |
| 2023 March | 58 | 2 | 60 |
| 2023 February | 59 | 8 | 67 |
| 2023 January | 90 | 2 | 92 |
| 2022 December | 44 | 4 | 48 |
| 2022 November | 32 | 6 | 38 |
| 2022 October | 24 | 3 | 27 |
| 2022 September | 23 | 19 | 42 |
| 2022 August | 28 | 10 | 38 |
| 2022 July | 25 | 6 | 31 |
| 2022 June | 14 | 8 | 22 |
| 2022 May | 21 | 5 | 26 |
| 2022 April | 41 | 8 | 49 |
| 2022 March | 63 | 10 | 73 |
| 2022 February | 51 | 4 | 55 |
| 2022 January | 98 | 6 | 104 |
| 2021 December | 55 | 11 | 66 |
| 2021 November | 48 | 6 | 54 |
| 2021 October | 45 | 15 | 60 |
| 2021 September | 29 | 12 | 41 |
| 2021 August | 44 | 8 | 52 |
| 2021 July | 34 | 6 | 40 |
| 2021 June | 27 | 11 | 38 |
| 2021 May | 38 | 11 | 49 |
| 2021 April | 50 | 13 | 63 |
| 2021 March | 30 | 10 | 40 |
| 2021 February | 43 | 10 | 53 |
| 2021 January | 25 | 9 | 34 |
| 2020 December | 36 | 4 | 40 |
| 2020 November | 25 | 2 | 27 |
| 2020 October | 17 | 5 | 22 |
| 2020 September | 31 | 9 | 40 |
| 2020 August | 27 | 7 | 34 |
| 2020 July | 12 | 6 | 18 |
| 2020 June | 12 | 7 | 19 |
| 2020 May | 23 | 7 | 30 |
| 2020 April | 10 | 4 | 14 |
| 2020 March | 11 | 2 | 13 |
| 2020 February | 13 | 3 | 16 |
| 2020 January | 9 | 1 | 10 |
| 2019 December | 14 | 6 | 20 |
| 2019 November | 14 | 5 | 19 |
| 2019 October | 15 | 6 | 21 |
| 2019 September | 19 | 2 | 21 |
| 2019 August | 5 | 9 | 14 |
| 2019 July | 21 | 9 | 30 |
| 2019 June | 39 | 24 | 63 |
| 2019 May | 75 | 34 | 109 |
| 2019 April | 61 | 6 | 67 |
| 2019 March | 5 | 1 | 6 |
| 2019 February | 3 | 4 | 7 |
| 2019 January | 4 | 0 | 4 |
| 2018 December | 5 | 2 | 7 |
| 2018 November | 6 | 2 | 8 |
| 2018 October | 15 | 5 | 20 |
| 2018 September | 10 | 2 | 12 |
| 2018 August | 5 | 0 | 5 |
| 2018 July | 5 | 1 | 6 |
| 2018 June | 6 | 1 | 7 |
| 2018 May | 12 | 2 | 14 |
| 2018 April | 6 | 0 | 6 |
| 2018 March | 2 | 1 | 3 |
| 2018 February | 9 | 2 | 11 |
| 2018 January | 9 | 0 | 9 |
| 2017 December | 9 | 2 | 11 |
| 2017 November | 9 | 0 | 9 |
| 2017 October | 10 | 3 | 13 |
| 2017 September | 2 | 1 | 3 |
| 2017 May | 1 | 0 | 1 |
| 2017 April | 3 | 0 | 3 |
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