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Brain abscess in childhood. A study of 34 cases treated by puncture and antibiotics
Insights
Puncturing pediatric brain abscesses, combined with antibiotics and intracranial pressure monitoring, leads to better outcomes than surgical excision. This approach reduces mortality and neurological sequelae in children.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
Background:
- Brain abscesses in children are serious infections.
- Commonly associated with congenital heart disease and ENT infections.
Purpose of the Study:
- To evaluate the efficacy of a standardized treatment protocol for pediatric brain abscesses.
- To compare outcomes of abscess puncture versus excision.
Main Methods:
- Retrospective analysis of 34 children treated for brain abscess over 15 years.
- Standardized protocol: abscess puncture, antibiotics, antiedematous drugs, intracranial pressure monitoring, and CT scans.
- Surgical excision was performed in 7 cases.
Main Results:
- Mortality rate was 12% overall (6% postoperative).
- Neurological sequelae were minimal; epilepsy occurred in 10% of cases.
- Mental retardation (18%) was linked to cyanotic congenital heart disease.
Conclusions:
- Abscess puncture is superior to excision for pediatric brain abscesses.
- The standardized protocol, including monitoring and imaging, improves patient outcomes.
- CT scans showed progressive capsule disappearance post-treatment.
Abstract:
During the last 15 years, 34 children were treated for a brain abscess. 13 (38%) had cyanotic heart disease; 12 (35%) had an ENT infection. The standardized treatment protocol included puncture of the abscess and administration of antibiotic and antiedematous drugs. Postoperative permanent epidural monitoring of intracranial pressure and, in the last 5 years, repeated CT scans indicated if retapping the abscess or reinforcing the antiedematous treatment was necessary. In 7 out of these 34 cases the abscess had to be excised. Postoperative mortality rate was 6%. Overall mortality rate was 12%. Neurological sequelae were slight. Epilepsy frequency was 10%. Mental retardation (18%) was found only in cyanotic congenital heart disease to which it is related. Repeated CT scans demonstrated the progressive disappearance of the capsule within a few months. This study shows an improvement in the results when brain abscesses in children are punctured rather than excised.