Endoscopic Transethmoid Drainage of Frontal Lobe Brain Abscess: Rare Case Report

A frontal lobe abscess is a common life-threatening brain emergency, with critical treatment relying on a combination of drainage and parenteral antibiotic medication. A 14-year-old female with type 1 diabetes mellitus was referred from the Department of Neurosurgery with a history of right-sided facial twitching repeating every 5 minutes and accompanied with pyrexia. An MRI scan revealed a 2 x 2 cm abscess in the frontal lobe, attached to skull base. Intravenous antibiotics were started, but after 12 hours, her consciousness deteriorated, therefore the abscess was urgently drained successfully via endoscopic transnasal transethmoid route. The skull base window was repaired using fat, tensor fascia lata and duraseal. The postoperative recovery was uneventful, with no cerebrospinal fluid leakage or meningitis, and patient's condition was satisfactory. Follow-up with an immediate CT scan MRI scan 3 months later showed no manifest of abscess returning. It was concluded that the transnasal transethmoid approach has the advantage of allowing the abscess to be identified and drained definitively without intra-cerebral penetration.