{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T09:55:13Z","timestamp":1789120513414,"version":"build-2803163510"},"reference-count":33,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Acute otomastoiditis (AOM) may occasionally progress to severe intracranial complications in children. While immunological and microbiological factors have been studied, the role of temporal bone anatomical variants remains less well-defined. The aim of this study is to investigate the prevalence of anatomical variants in pediatric patients with acute complicated otomastoiditis (ACOM) compared to those with uncomplicated ones (AUOM) and healthy controls (HC) and assess their potential association with intracranial complication patterns. Methods: This retrospective, single-center study reviewed clinical and neuroradiological data of patients aged 0\u201316 years admitted for AOM between 2018 and 2025. ACOM patients were compared to AUOM and HC groups (the latter undergoing neuroimaging for minor head trauma). Two experienced neuroradiologists evaluated imaging to identify anatomical variants involving the following: (1) sigmoid sinus and emissary veins; (2) tegmen tympani; and (3) mastoid pneumatization. Statistical analyses assessed prevalence differences across groups. Results: Among 282 AOM patients, 58 had intracranial complications. Anatomical variants were significantly more frequent in ACOM patients versus both AUOM and HC (p &lt; 0.01). In this subgroup, vascular anatomical variants were notably associated with vascular or combined (vascular and infectious) complications; tegmen tympani and mastoid pneumatization variants showed no significant subgroup associations. Conclusion: Anatomical variants, particularly vascular anomalies of the sigmoid sinus and emissary veins, appear to increase pediatric AOM patients\u2019 susceptibility to intracranial complications. Recognition of these configurations through early neuroimaging could aid risk stratification and improve diagnostic and therapeutic strategies.<\/jats:p>","DOI":"10.3390\/jcm14217715","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:28:43Z","timestamp":1761888523000},"page":"7715","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Acute Otomastoiditis in Children: An Observational Study on the Role of Mastoid Morphology in the Development of Intracranial Complications"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2256-7281","authenticated-orcid":false,"given":"Camilla","family":"Russo","sequence":"first","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Coluccino","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1679-4437","authenticated-orcid":false,"given":"Marco","family":"Sarno","sequence":"additional","affiliation":[{"name":"Chronic and Multifactorial Diseases Unit, Department of General and Emergency Pediatrics, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6997-8950","authenticated-orcid":false,"given":"Antonia","family":"Pascarella","sequence":"additional","affiliation":[{"name":"Chronic and Multifactorial Diseases Unit, Department of General and Emergency Pediatrics, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alida","family":"Casale","sequence":"additional","affiliation":[{"name":"Chronic and Multifactorial Diseases Unit, Department of General and Emergency Pediatrics, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonietta","family":"De Lucia","sequence":"additional","affiliation":[{"name":"Otology and Cochlear Implant Unit, Department of Surgical Specialties, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7758-8605","authenticated-orcid":false,"given":"Pietro","family":"Spennato","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neurosciences, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Cascone","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Cicala","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmela","family":"Russo","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6079-4063","authenticated-orcid":false,"given":"Daniele","family":"De Brasi","sequence":"additional","affiliation":[{"name":"Medical Genetics Unit, Department of General and Emergency Pediatrics, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7797-8483","authenticated-orcid":false,"given":"Giuseppe","family":"Cinalli","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Department of Neurosciences, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7241-8949","authenticated-orcid":false,"given":"Antonio","family":"Della Volpe","sequence":"additional","affiliation":[{"name":"Otology and Cochlear Implant Unit, Department of Surgical Specialties, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Siani","sequence":"additional","affiliation":[{"name":"Chronic and Multifactorial Diseases Unit, Department of General and Emergency Pediatrics, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio Maria","family":"Covelli","sequence":"additional","affiliation":[{"name":"Neuroradiology Unit, Department of Neuroscience, Santobono-Pausilipon Children\u2019s Hospital, AORN, 80129 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","first-page":"54","article-title":"Acute mastoiditis in children","volume":"91","author":"Cassano","year":"2020","journal-title":"Acta Biomed."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1097\/00005537-200310000-00004","article-title":"Natural 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