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We've discussed some of the

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orbital complications of sinusitis.

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Let's move to the intracranial

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complications of sinusitis.

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The intracranial complications of

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sinusitis are usually derived from a

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frontal sinusitis or a sphenoid sinusitis.

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The sphenoid sinus and the posterior ethmoid

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sinuses adjacent to the cavernous sinus may

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lead to some of the intracranial or vascular

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complications of sinusitis. With a frontal sinusitis,

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you may see that there is some involvement of

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the frontal extra-axial space, and when we're

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talking about the frontal extra-axial space, these

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infections that can extend there

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may be subdural, or they may be epidural,

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depending upon whether or not they are

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peeling off the periosteum of the calvarium.

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So here we have a patient who has opacification of the

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frontal sinus, predominantly on the left side. We see

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some areas where there is some thinning of the bone.

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Although this is not all that dramatic,

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and yet here on the non-contrast CT scan,

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we can faintly see an extra-axial collection.

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Now, as I said, most of these are gonna be in

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the epidural space because they tend to lift

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the periosteum from the calvarium and therefore

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are in the epidural space, as opposed to going

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through that dura and being in the subdural space.

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But you may see

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one or both.

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Here we have a coronal scan and a different patient

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who had sphenoid sinusitis with opacification, 34 00:01:40,200 --> 00:01:44,730 faintly seen is this epidural collection with rim

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enhancement along the sella with low density centrally.

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This was an epidural abscess

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secondary to sphenoid sinusitis.

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This is the diagram given to me again by

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Azita Khorsandi of potential complications

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that can occur with frontal sinusitis.

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Here we have the frontal sinus,

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which is opacified, and we noticed that there

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is lifting up of the periosteum here.

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Here's the periosteum,

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and being lifted,

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so this is outside the periosteum, and therefore

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in the epidural space. You may see that

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infection lead to thrombosis of veins that are

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draining either from the scalp or intracranially,

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aand these thrombosed veins may

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subsequently lead to either mass effect

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or thrombosis of the sagittal sinus.

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Occasionally, as I mentioned, this infection

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will actually perforate through the periosteum

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of the calvarium and reside in the subdural

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space and lead to an infection in that location.

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So the potential complications of frontal

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sinusitis, in addition to osteomyelitis, there may

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be a soft tissue mass anteriorly in the scalp.

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We'll talk about this shortly.

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It's called Pott's puffy tumor.

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We have the septic phlebitis.

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We have this potential sinus thrombosis.

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66 00:03:22,109 --> 00:03:24,120 Here is an MRI scan.

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We see the frontal sinusitis with

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post-gadolinium enhanced imaging.

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This is a very unusual shape to this collection.

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Would be unusual for both an epidural as well

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as subdural, but in this case an epidural

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abscess with associated inflammation of

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the meninges accounting for the meningitis.

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So a lot of potential complications

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arising from frontal sinusitis.