. they can be caused by trauma , neurosurgical procedures , hematogenious   and contiguous spreading of an infection . the mortality depends on the time of diagnosis and is 10% . around 50% of the patients the patients appear with headache , fever , nausea , seizures and neurological deficits . for the diagnosis of subdural empyema , contrast - enhanced ct scan or better mri are gold - standard diagnostic methods . bacterial parafalcine empyemas rarely obey as a complication of bacterial sinusitis . in our study , we present two cases of children developing a parafalcine empyema as a consequence of a frontal sinusitis diagnosed by an ent . first we started the review with searching pubmed for articles referring to  brain abscesses in children ' ( 2056 ) and continued our quest with another path was looking for subdural empyemas in children ( 331 hits ) and at last we found four articles concerning to parafalcine subdural empyemas in children . additionally , we describe two cases of parafalcine abscesses in children as a complication of a sinusitis frontalis treated in our own department . the patients charts and images the first case is a 12-year - old boy who came to our department with a diagnosed sinusitis frontalis . irrespective of the initiated antibiotic therapy , he developed a hemiparesis on the right side and worsening headache . 1a ) showed a parafalcine subdural empyema frontoparietal with a left side compression of the brain . the abscess was drained by a left parasagittal approach with neuronavigation . after draining the abscess the brain did not extend sufficiently , so we decided to put in a drainage for 2days to drain potential abscess material and to avoid a relapse of the subdural empyema . we expanded the antibiotic therapy from a single therapy to a triple therapy with amoxicillin , metronidazole and cefotaxim despite the absence of bacteria in growth culture . in spite of surgery and the antibiotic therapy , an eeg showed pathological alterations and typical epileptical activity , convulsions were observed as well and a ct scan ( fig . owing to the clinical aggravation and the increase of the abscess size , we decided to perform a second surgery . afterwards , we irrigated the abscess cavity with isotonic saline solution and put in a drainage . the antibiotic therapy was given for 3months under regularly control of infection parameters once a week and the symptomatic epilepsy was treated with levetiracetam . 1c ) , which showed a regression of the abscess and another mri 3months after the second surgery showed no further abscess . until then the patient was seizure free . 
 figure  1:twelve - year - old boy with parafalcine subdural empyema . ( a ) axial and saggital mri section with administration of gadolinium . a parafalcine subdural empyema frontoparietal with left - side compression of the brain . an enlargement of the empyema is visible 4days after first surgery with a diffuse edema of the left hemisphere without a significant midline shift . a regressive edema of the left hemisphere is visible , especially the frontal abscess conglomerate is reduced . ( a ) axial and saggital mri section with administration of gadolinium . a parafalcine subdural empyema frontoparietal with left - side compression of the brain . an enlargement of the empyema is visible 4days after first surgery with a diffuse edema of the left hemisphere without a significant midline shift . a regressive edema of the left hemisphere is visible , especially the frontal abscess conglomerate is reduced . an 8-year - old girl with a diagnosed sinusitis frontalis , already under antibiotic therapy , developed progressive headaches and increasing infection parameters . the girl 's symptoms were nausea , emesis , headache and fever but no neurological disturbance . we drained the empyema by a right frontal craniotomy and clear the abscess cavity with isotonic saline solution . after surgery , the girl 's condition got worse with seizures and fever . in a repeated mri ( fig . we decided to revise and extend the approach to remove the capsule of the empyema which could be seen perioperatively . the empyema is localized in central parasagittal region with a significant space - occupying component with a compression of the right central region . a regression is visible after second surgery . in comparison to preoperative mri , a notable decrease in the space - occupying part of the empyema the empyema is localized in central parasagittal region with a significant space - occupying component with a compression of the right central region . a regression is visible after second surgery . in comparison to preoperative mri , a notable decrease in the space - occupying part of the empyema is seen . afterwards , the girl stayed for another week in our department . at the day of discharge , for example , banerjee et al . described 65 pediatric patients with supratentorial subdural empyemas and recommend an early surgical drainage , preferably craniotomy , eradication of pus and sensitive broad - spectrum antibiotics . described 41 cases with subdural empyemas from 1977 until 1988 , only four of patients had parafalcine collection . our both children had parafalcine empyemas as a complication of a sinusitis frontalis . in spite of antibiotic therapy and surgery , the empyemas in both patients showed an enlargement after a few days after the first craniotomy . the symptoms of parafalcine empyemas can vary from unspecific symptoms like fever and headache to neurological symptoms like hemiparesis , impairment of consciousness until seizures . the most pediatric brain abscesses generally occur with headache ( 48% ) , fever ( 48% ) , nausea  vomiting ( 36% ) and seizures ( 29.3% ) . the neurological symptoms like cranial nerve palsy and hemiparesis of course depends on the localization of the lesion . the results of our case series showed that parafalcine empyemas seem to be a rare complication with high mortality if not treated quickly . in both cases after the first surgery with drainage of the abscess , the symptoms reappeared and the abscess increased as seen in the follow - up ct and mri . it is important in pediatric cases with parafalcine empyemas to perform a follow - up ct or mri 47 days after the surgical evacuation . since both children showed pathological activity in eeg , we suggest an eeg 47 days post - surgery . the treatment of choice should be a combination of surgery and antibiotic therapy and if it is necessary antiepileptic therapy too . optimal and fast microbiological probe acquisition and communication with the laboratory is extremely important . for early diagnosis , a contrast - enhanced ct scan and a non - enhanced scan
subdural intracranial empyemas and brain abscesses are a rare complication of bacterial sinusitis . 
 pediatric parafalcine abscesses are a rare entity with different treatment compared with other brain abscesses . 
 we present two pediatric cases with falcine abscess as a sinusitis complication and introduce our department s treatment management . 
 in addition a review of literature is performed . 
 surgical cases of our department and their management are compared with the current literature . in our cases , 
 both of the children showed a recurrent empyema after the first surgical treatment and antibiotic therapy . 
 a second surgical evacuation was necessary . 
 the antibiotic therapy was given for 3 months . 
 short - time follow - up imaging is necessary irrespective of infection parameters in blood and patient 's clinical condition . especially in parafalcine 
 abscesses a second look may be an option and surgical treatment with evacuation of pus is the treatment of choice if abscess remnants are visualized .