{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T10:57:30Z","timestamp":1770116250160,"version":"3.49.0"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"9","license":[{"start":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T00:00:00Z","timestamp":1740960000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Cosmet Laser Ther"],"published-print":{"date-parts":[[2025,3,3]]},"abstract":"\n BACKGROUND<\/jats:title>\n Management of intracranial epidural abscess (ICEA) typically requires a combination of surgical drainage and antibiotic therapy. However, the indications for neurosurgical drainage of ICEA have not been well established by evidence-based data and remain controversial. This article describes a case of ICEA that enlarged during antibiotic therapy but was managed successfully without neurosurgical drainage.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 13-year-old boy was admitted to the authors\u2019 hospital with a 6-day history of high fever, fatigue, and headache. Computed tomography and magnetic resonance imaging (MRI) revealed an ICEA in the right middle fossa with right-sided sinusitis. Initial empiric intravenous antibiotic therapy resulted in rapid improvement in clinical course. Despite clinical improvement, the abscess progressively enlarged by 158% after 2 weeks. Based on the patient\u2019s symptoms, age, and location of the lesion and considering the invasive surgical risks, neurosurgical drainage was not performed. Subsequently, the abscess began to decrease in size, and the patient was discharged after 5 weeks of hospitalization. Follow-up MRI at 6 months confirmed complete resolution of the abscess.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n Despite abscess enlargement, conservative management might be feasible when the patient demonstrates symptomatic improvement; thus, a tailored approach combining close monitoring with serial imaging is recommended.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE24702<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case24702","type":"journal-article","created":{"date-parts":[[2025,3,3]],"date-time":"2025-03-03T01:54:04Z","timestamp":1740966844000},"source":"Crossref","is-referenced-by-count":0,"title":["Conservative management of an expanding intracranial epidural abscess: illustrative case"],"prefix":"10.3171","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0095-3737","authenticated-orcid":true,"given":"Yukihiro","family":"Nakamura","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan"},{"name":"Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6910-1959","authenticated-orcid":true,"given":"Takahiro","family":"Sanada","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan"},{"name":"Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Tucker","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6614-1258","authenticated-orcid":true,"given":"Seiya","family":"Fujikawa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan"},{"name":"Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomoki","family":"Fujiwara","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7923-6902","authenticated-orcid":true,"given":"Manabu","family":"Kinoshita","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teruo","family":"Kimura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Japanese Red Cross Kitami Hospital, Kitami, Hokkaido, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"3","key":"bib1","series-title":"Lancet Neurol","first-page":"292","article-title":"Epidural abscesses of the CNS","volume":"8","author":"Pradilla","year":"2009","unstructured":"Pradilla GArdila GPHsu WRigamonti D.Epidural abscesses of the CNS. Lancet Neurol. 2009;8(3):292-300."},{"issue":"suppl 1","key":"bib2","series-title":"J Infect","first-page":"S42","article-title":"Pediatric intracranial abscesses","volume":"71","author":"Bonfield","year":"2015","unstructured":"Bonfield CMSharma JDobson S.Pediatric intracranial abscesses. J Infect. 2015;71(suppl 1):S42-S46."},{"issue":"4","key":"bib3","series-title":"Scand J Surg","first-page":"254","article-title":"Intracranial suppurative complications of sinusitis","volume":"105","author":"Nicoli","year":"2016","unstructured":"Nicoli TKOinas MNiemel\u00e4 MM\u00e4kitie AAAtula T.Intracranial suppurative complications of sinusitis. Scand J Surg. 2016;105(4):254-262."},{"issue":"4","key":"bib4","series-title":"Neurosurgery","first-page":"893","article-title":"Conservative neurosurgical management of intracranial epidural abscesses in children","volume":"53","author":"Heran","year":"2003","unstructured":"Heran NSSteinbok PCochrane DD.Conservative neurosurgical management of intracranial epidural abscesses in children. Neurosurgery. 2003;53(4):893-897."},{"issue":"6","key":"bib5","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"868","article-title":"Management and outcomes in children with sinogenic intracranial abscesses","volume":"79","author":"Patel","year":"2015","unstructured":"Patel APMasterson LDeutsch CJScoffings DJFish BM.Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol. 2015;79(6):868-873."},{"issue":"4","key":"bib6","series-title":"Neuroradiology","first-page":"220","article-title":"Diffusion-weighted MRI of subdural and epidural empyemas","volume":"45","author":"Tsuchiya","year":"2003","unstructured":"Tsuchiya KOsawa AKatase SFujikawa AHachiya JAoki S.Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology. 2003;45(4):220-223."},{"issue":"1","key":"bib7","series-title":"Clin Microbiol Infect","first-page":"66","article-title":"European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults","volume":"30","author":"Bodilsen","year":"2024","unstructured":"Bodilsen JD\u2019Alessandris QGHumphreys HEuropean society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66-89."},{"issue":"5","key":"bib8","series-title":"Neurosurgery","first-page":"1079","article-title":"Bacterial brain abscesses expand despite effective antibiotic treatment: a process powered by osmosis due to neutrophil cell death","volume":"94","author":"Dahlberg","year":"2023","unstructured":"Dahlberg DHolm SSagen EMLBacterial brain abscesses expand despite effective antibiotic treatment: a process powered by osmosis due to neutrophil cell death. Neurosurgery. 2023;94(5):1079-1087."},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"264","article-title":"Role of vascular proliferation on angiographic appearance and encapsulation of experimental traumatic and metastatic brain abscesses","volume":"48","author":"Wood","year":"1978","unstructured":"Wood JHDoppman JLLightfoote WEGirton MOmmaya AK.Role of vascular proliferation on angiographic appearance and encapsulation of experimental traumatic and metastatic brain abscesses. J Neurosurg. 1978;48(2):264-273."},{"issue":"4","key":"bib10","series-title":"J Neurosurg","first-page":"590","article-title":"Neuropathological and computerized tomographic findings in experimental brain abscess","volume":"55","author":"Britt","year":"1981","unstructured":"Britt RHEnzmann DRYeager AS.Neuropathological and computerized tomographic findings in experimental brain abscess. J Neurosurg. 1981;55(4):590-603."},{"issue":"1","key":"bib11","series-title":"Am J Otolaryngol","first-page":"25","article-title":"Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting","volume":"31","author":"DelGaudio","year":"2010","unstructured":"DelGaudio JMEvans SHSobol SEParikh SL.Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting. Am J Otolaryngol. 2010;31(1):25-28."},{"issue":"7","key":"bib12","series-title":"J Neurosurg Case Lessons","first-page":"CASE24288","article-title":"Endoscopic endonasal drainage of a middle fossa epidural abscess in conjunction with endoscopic sinus surgery: illustrative case","volume":"8","author":"Hasegawa","year":"2024","unstructured":"Hasegawa HKondo KIshihara SEndoscopic endonasal drainage of a middle fossa epidural abscess in conjunction with endoscopic sinus surgery: illustrative case. J Neurosurg Case Lessons. 2024;8(7):CASE24288."},{"issue":"4","key":"bib13","series-title":"Brain Dev","first-page":"359","article-title":"Twelve-year-old girl with intracranial epidural abscess and sphenoiditis","volume":"36","author":"Seto","year":"2014","unstructured":"Seto TTakesada HMatsushita NTwelve-year-old girl with intracranial epidural abscess and sphenoiditis. Brain Dev. 2014;36(4):359-361."},{"issue":"3","key":"bib1","series-title":"Lancet Neurol","first-page":"292","article-title":"Epidural abscesses of the CNS","volume":"8","author":"Pradilla","year":"2009","unstructured":"Pradilla GArdila GPHsu WRigamonti D.Epidural abscesses of the CNS. Lancet Neurol. 2009;8(3):292-300."},{"issue":"suppl 1","key":"bib2","series-title":"J Infect","first-page":"S42","article-title":"Pediatric intracranial abscesses","volume":"71","author":"Bonfield","year":"2015","unstructured":"Bonfield CMSharma JDobson S.Pediatric intracranial abscesses. J Infect. 2015;71(suppl 1):S42-S46."},{"issue":"4","key":"bib3","series-title":"Scand J Surg","first-page":"254","article-title":"Intracranial suppurative complications of sinusitis","volume":"105","author":"Nicoli","year":"2016","unstructured":"Nicoli TKOinas MNiemel\u00e4 MM\u00e4kitie AAAtula T.Intracranial suppurative complications of sinusitis. Scand J Surg. 2016;105(4):254-262."},{"issue":"4","key":"bib4","series-title":"Neurosurgery","first-page":"893","article-title":"Conservative neurosurgical management of intracranial epidural abscesses in children","volume":"53","author":"Heran","year":"2003","unstructured":"Heran NSSteinbok PCochrane DD.Conservative neurosurgical management of intracranial epidural abscesses in children. Neurosurgery. 2003;53(4):893-897."},{"issue":"6","key":"bib5","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"868","article-title":"Management and outcomes in children with sinogenic intracranial abscesses","volume":"79","author":"Patel","year":"2015","unstructured":"Patel APMasterson LDeutsch CJScoffings DJFish BM.Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol. 2015;79(6):868-873."},{"issue":"4","key":"bib6","series-title":"Neuroradiology","first-page":"220","article-title":"Diffusion-weighted MRI of subdural and epidural empyemas","volume":"45","author":"Tsuchiya","year":"2003","unstructured":"Tsuchiya KOsawa AKatase SFujikawa AHachiya JAoki S.Diffusion-weighted MRI of subdural and epidural empyemas. Neuroradiology. 2003;45(4):220-223."},{"issue":"1","key":"bib7","series-title":"Clin Microbiol Infect","first-page":"66","article-title":"European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults","volume":"30","author":"Bodilsen","year":"2024","unstructured":"Bodilsen JD\u2019Alessandris QGHumphreys HEuropean society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66-89."},{"issue":"5","key":"bib8","series-title":"Neurosurgery","first-page":"1079","article-title":"Bacterial brain abscesses expand despite effective antibiotic treatment: a process powered by osmosis due to neutrophil cell death","volume":"94","author":"Dahlberg","year":"2023","unstructured":"Dahlberg DHolm SSagen EMLBacterial brain abscesses expand despite effective antibiotic treatment: a process powered by osmosis due to neutrophil cell death. Neurosurgery. 2023;94(5):1079-1087."},{"issue":"2","key":"bib9","series-title":"J Neurosurg","first-page":"264","article-title":"Role of vascular proliferation on angiographic appearance and encapsulation of experimental traumatic and metastatic brain abscesses","volume":"48","author":"Wood","year":"1978","unstructured":"Wood JHDoppman JLLightfoote WEGirton MOmmaya AK.Role of vascular proliferation on angiographic appearance and encapsulation of experimental traumatic and metastatic brain abscesses. J Neurosurg. 1978;48(2):264-273."},{"issue":"4","key":"bib10","series-title":"J Neurosurg","first-page":"590","article-title":"Neuropathological and computerized tomographic findings in experimental brain abscess","volume":"55","author":"Britt","year":"1981","unstructured":"Britt RHEnzmann DRYeager AS.Neuropathological and computerized tomographic findings in experimental brain abscess. J Neurosurg. 1981;55(4):590-603."},{"issue":"1","key":"bib11","series-title":"Am J Otolaryngol","first-page":"25","article-title":"Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting","volume":"31","author":"DelGaudio","year":"2010","unstructured":"DelGaudio JMEvans SHSobol SEParikh SL.Intracranial complications of sinusitis: what is the role of endoscopic sinus surgery in the acute setting. Am J Otolaryngol. 2010;31(1):25-28."},{"issue":"7","key":"bib12","series-title":"J Neurosurg Case Lessons","first-page":"CASE24288","article-title":"Endoscopic endonasal drainage of a middle fossa epidural abscess in conjunction with endoscopic sinus surgery: illustrative case","volume":"8","author":"Hasegawa","year":"2024","unstructured":"Hasegawa HKondo KIshihara SEndoscopic endonasal drainage of a middle fossa epidural abscess in conjunction with endoscopic sinus surgery: illustrative case. J Neurosurg Case Lessons. 2024;8(7):CASE24288."},{"issue":"4","key":"bib13","series-title":"Brain Dev","first-page":"359","article-title":"Twelve-year-old girl with intracranial epidural abscess and sphenoiditis","volume":"36","author":"Seto","year":"2014","unstructured":"Seto TTakesada HMatsushita NTwelve-year-old girl with intracranial epidural abscess and sphenoiditis. Brain Dev. 2014;36(4):359-361."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/9\/article-CASE24702.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/9\/article-CASE24702.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/9\/9\/article-CASE24702.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T23:37:51Z","timestamp":1770075471000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/9\/9\/article-CASE24702.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,3]]},"references-count":26,"journal-issue":{"issue":"9"},"URL":"https:\/\/doi.org\/10.3171\/case24702","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,3]]}}}