Objectives: To evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. Design: Retrospective cohort study. Setting: A single paediatric tertiary unit. Participants: Patients younger than 18 years with radiologically confirmed intracranial abscess including subdural empyema (SDE), epidural (EDA) or intraparenchymal (IPA) abscess secondary to sinusitis. Main outcome measures: The rates of return to theatre, the length of hospital stay (LOS), death <90 days and neurological disability (ND) at 6 months. Results: A cohort of 39 consecutive patients (41% male, mean age 11.5) presenting between 2000-2020 were eligible for inclusion. SDE was the most common intracranial complication (n=25, 64%) followed by EDA (n=12, 31%) and IPA (n=7, 18%). The mean LOS was 42 days (SD 16). Sixteen patients (41%) were managed with combined ENT and neurosurgical interventions, 15 (38.5%) underwent ENT procedure alone and 4 (10.3%) had neurosurgical only drainage. Four patients initially underwent non-operative management. The rates of return to theatre, ND and 90-day mortality were 19 (48.7%), 9 (23.1%) and 3 (7.7%) respectively and were comparable across the four treatment arms. In the univariate logistic regression, only the size of an intracranial abscess (10mm) was found be associated with an increased likelihood of return to theatre (odds radio 7, confidence interval 1.09-45.1), while combined ENT and neurosurgical intervention did not result in improved outcomes. Conclusion: Sinogenic intracranial abscesses are associated with a significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.