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Paediatric intracranial empyema: differences according to age

Matthieu Legrand1, Thomas Roujeau, Philippe Meyer

  • 1Department of Anesthesiology and Critical Care, Necker-Enfants Malades Hospital, AP-HP, University Paris Descartes, 75015 Paris, France. m.legrand@libertysurf.fr

European Journal of Pediatrics
|January 13, 2009
PubMed

Insights

Paediatric intracranial empyema (PICE) outcomes vary by age, with infants recovering fully and older children facing potential deficits. Early diagnosis and multidisciplinary treatment are crucial for better PICE outcomes.

Area of Science:

  • Pediatric Neurology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Recent studies on pediatric intracranial empyema (PICE) epidemiology and outcomes are lacking.
  • Paediatric intracranial empyema (PICE) is a serious condition requiring timely intervention.

Purpose of the Study:

  • To analyze the epidemiology and outcomes of pediatric intracranial empyema (PICE).
  • To identify age-related etiological factors, clinical features, and risk factors for poor outcomes in PICE.

Main Methods:

  • Retrospective study of 38 PICE cases (1993-2006).
  • Analysis of etiology, clinical presentation, treatment, and Glasgow Outcome Scale (GOS) at 24 months.
  • Age-stratified analysis for infants (<1 year) and children.

Main Results:

  • Subdural empyema (SDE) was more common (33/38) than extradural empyema (EDE) (5/38).
  • Infants with SDE (n=10) secondary to meningitis recovered completely.
  • Children with EDE (n=5) also recovered fully; however, 2/23 children with SDE had neurological deficits and 1 died.
  • Neurological deficit and cerebral herniation on admission were poor outcome predictors in children with SDE.
  • Oto-sinogenic infections were the primary cause in children, while meningitis predominated in infants.

Conclusions:

  • PICE epidemiology and outcomes differ significantly with age.
  • Early neuro-imaging diagnosis and prompt, multidisciplinary treatment are vital for favorable PICE outcomes.
  • Surgical recurrence was noted, particularly after burr hole procedures.

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