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Pediatric cerebral abscess
S D Moss1, D G McLone, M Arditi
1Department of Neurological Surgery, Northwestern University, Children's Memorial Hospital, Chicago, Ill.
Insights
Pediatric cerebral abscesses are complex, with varied causes and treatments. Surgical intervention, particularly resection or evacuation, significantly improves outcomes compared to aspiration, with CT scans enhancing diagnosis and reducing mortality.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
Background:
- Cerebral abscesses in children present a significant neurosurgical challenge.
- Historical treatment approaches varied, impacting patient outcomes.
Observation:
- A review of 54 pediatric cerebral abscess cases from 1958-1987 revealed diverse etiologies, including cyanotic heart disease, hydrocephalus/shunt infections, sinusitis, otitis, and tuberculomas.
- Organisms identified included streptococci (26%), staphylococci (9%), and fungi (7%), with 26% of cultures remaining negative.
- Underlying conditions were absent in 19% of cases.
Findings:
- Surgical resection or evacuation of cerebral abscesses demonstrated lower mortality rates (7-9%) compared to aspiration (17%).
- Patient's clinical status on admission was the strongest predictor of mortality.
- The introduction of CT scanning dramatically reduced overall mortality from 31% to 5.7% and surgical mortality from 21% to 2.9%.
Implications:
- Aggressive surgical management, especially resection and evacuation, is crucial for improving survival in pediatric cerebral abscess.
- Early diagnosis and intervention, facilitated by advanced imaging like CT scans, are vital for reducing morbidity and mortality.
- Understanding the diverse etiologies and risk factors is essential for tailored treatment strategies in pediatric neurosurgery.
Abstract:
Fifty-four consecutive cases of children with cerebral abscess from 1958 to 1987 are reviewed. Their average age was 6.6 years, ranging from 3 days to 19 years. A wide range of organisms and underlying diseases was encountered. The predominant mode of surgical therapy was craniotomy with resection of the abscess. Aspiration and craniotomy with drainage-evacuation were also employed in our series. No underlying disease was found in 10 (19%) of the children. Cyanotic heart disease (CHD) was present in 13 (24%) of the children. Four children had dental abscesses and 1 had otitis media. Seven (13%) children had abscesses secondary to hydrocephalus/shunt infections. Sinusitis and otitis accounted for 5 cases (9%). Four children (7%) had tuberculomas. One abscess was associated with a nasal dermal sinus and one was congenital. Fourteen (26%) patients had negative cultures. Fourteen (26%) abscesses contained streptococci of various types. Staphylococci were found in only 5 (9%) of the abscesses. The congenital abscess was caused by salmonella. Two abscesses (7%) were fungal. Both of these patients died. Six children (11%) were treated without surgical intervention. Three of them died. Forty-eight children had surgical intervention; 12 underwent aspiration, 14 underwent open evacuation of the abscess, and 22 had abscesses resected. Mortality in the aspiration group was twice that of the evacuation or resection group (17, 7 and 9%), respectively). The factor which correlated best with mortality was the patient's clinical status on admission. The advent of CT scan at our facility improved mortality by facilitating accurate diagnosis and surgical intervention. Overall mortality rates decreased from 31 to 5.7% and surgical mortality fell from 21 to 2.9%.