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Postmeningitis subdural fluid collection in infants: changing pattern and indications for surgery
Matrhieu Vinchon1, Sylvie Joriot, Patrice Jissendi-Tchofo
1Department of Pediatric Neurosurgery, CHRU de Lille, France. m-vinchon@chru-lille.fr
Journal of Neurosurgery
|June 17, 2006
Summary
Postmeningitis subdural fluid collections (PMSFC) in infants are now primarily caused by Neisseria meningitidis. Surgical drain placement is recommended for PMSFC with significant mass effect on imaging.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric Neurology
- Neurosurgery
Background:
- Postmeningitis subdural fluid collection (PMSFC) is a known complication of bacterial meningitis in infants.
- Historically, Haemophilus influenzae was the most common cause, with high incidence rates when diagnosed by subdural puncture (SDP).
- Advances in imaging and vaccination have altered the landscape of PMSFC diagnosis and etiology.
Purpose of the Study:
- To re-evaluate the diagnostic, bacteriological, and surgical indications for PMSFC in infants.
- To assess the current causative agents and management strategies for PMSFC.
- To provide updated insights into this pediatric complication of meningitis.
Main Methods:
- Retrospective review of infant PMSFC cases diagnosed via CT and confirmed by SDP.
- Treatment involved subdural drain placement for collections with mass effect or clinical significance.
- Analysis of patient demographics, causative bacteria, and treatment outcomes over 26 years.
Main Results:
- Neisseria meningitidis has emerged as the predominant pathogen causing PMSFC.
- An estimated 5% of infant Neisseria meningitidis infections are complicated by significant PMSFC.
- Surgical drainage was required in 20 of 29 treated cases, with five requiring craniotomy.
Conclusions:
- Neisseria meningitidis is the leading cause of PMSFC in infants currently.
- Temporary surgical drain placement is advised for all PMSFC demonstrating significant mass effect on imaging.
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