Pott’s puffy tumour in adolescents: A three-case series of diverse intracranial complications from a Nigerian neurosurgical centre

Pott’s puffy tumour remains an important clinical entity despite advances in antimicrobial therapy, owing to its propensity for intracranial extension and potential for adverse outcomes. We report three adolescents with Pott’s puffy tumour managed at a Nigerian neurosurgical centre, highlighting the spectrum of intracranial complications, including a rare case of interhemispheric subdural empyema. Three adolescent males aged 15–18 years presented with frontal scalp swelling, headache and fever following paranasal sinus infection. Neuroimaging demonstrated frontal sinusitis with associated intracranial suppurative complications. The first patient had a bifrontal extradural abscess and underwent drainage of the subperiosteal and extradural abscesses with excision of the necrotic frontal bone, combined with functional endoscopic sinus surgery, resulting in complete recovery. The second patient presented with seizure and hemiparesis secondary to frontal convexity and interhemispheric subdural empyema. He underwent burr hole drainage of both empyemas with endoscopic sinus surgery and achieved complete neurological recovery following prolonged antimicrobial therapy. The third patient had frontal osteomyelitis, a frontal subperiosteal abscess with a right frontal extradural abscess but was discharged against medical advice before definite surgical treatment because of financial constraints. Pott’s puffy tumour remains an important complication of frontal sinusitis in adolescents and should prompt careful evaluation for intracranial extension. Early multidisciplinary management, incorporating timely neurosurgical drainage, definitive treatment of the underlying sinus infection, and antimicrobial therapy results in favourable outcome. This series broadens the recognized spectrum of intracranial complications associated with Pott’s puffy tumour by highlighting the occurrence of interhemispheric subdural empyema in this clinical setting.