Occipital abscess associated with cholesteatoma: a case illustrating possible infectious spread

• First reported occipital subperiosteal abscess secondary to pediatric cholesteatoma. • Infection spread via thrombosed sigmoid sinus and patent mastoid emissary vein. • CT and contrast MRI delineated sinus thrombosis, tract, and occipital abscesses. • Modified radical mastoidectomy with abscess drainage achieved durable cure.