BACKGROUND: This case report describes a transadnexal transorbital roof approach to the anterior cranial fossa to treat an epidural abscess in a patient who had previously undergone extensive craniofacial reconstruction secondary to fibrous dysplasia. A standard frontal craniotomy or even a supraciliary craniotomy would have been burdensome due to the positioning of the porous polyethylene implant as well as extensive scar tissue and adhesions from prior surgical procedures. METHODS: We performed a retrospective review of the case of a 15-year-old male with an epidural abscess treated at a university hospital. RESULTS: The patient tolerated the procedure well with no postoperative complications. Surgical operative time was approximately 1.5 h with minimal blood loss and the patient was discharged on postoperative day 2. Six weeks after antibiotic therapy (intravenous ampicillin/sulbactam, 2,000 mg q.i.d. for 6 days total), an MRI showed complete resolution of the epidural abscess. At that time the patient had no visual changes, extraocular muscle dysfunction, headaches, periorbital cellulitis, or further seizures and is on no antiepileptic therapy. CONCLUSION: Minimally invasive approaches to treat complex problems in certain circumstances can yield excellent results and limit morbidity encountered by more extensive procedures. In the future, more formal studies with a larger subset of patients will help determine what role these approaches will ultimately have. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
BACKGROUND: This case report describes a transadnexal transorbital roof approach to the anterior cranial fossa to treat an epidural abscess in a patient who had previously undergone extensive craniofacial reconstruction secondary to fibrous dysplasia. A standard frontal craniotomy or even a supraciliary craniotomy would have been burdensome due to the positioning of the porous polyethylene implant as well as extensive scar tissue and adhesions from prior surgical procedures. METHODS: We performed a retrospective review of the case of a 15-year-old male with an epidural abscess treated at a university hospital. RESULTS: The patient tolerated the procedure well with no postoperative complications. Surgical operative time was approximately 1.5 h with minimal blood loss and the patient was discharged on postoperative day 2. Six weeks after antibiotic therapy (intravenous ampicillin/sulbactam, 2,000 mg q.i.d. for 6 days total), an MRI showed complete resolution of the epidural abscess. At that time the patient had no visual changes, extraocular muscle dysfunction, headaches, periorbital cellulitis, or further seizures and is on no antiepileptic therapy. CONCLUSION: Minimally invasive approaches to treat complex problems in certain circumstances can yield excellent results and limit morbidity encountered by more extensive procedures. In the future, more formal studies with a larger subset of patients will help determine what role these approaches will ultimately have. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .