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[Cerebral abscesses in children treated by puncture. A 16 year-experience]
Insights
This study on pediatric brain abscesses found that surgical puncture, combined with antibiotics and ICP monitoring, led to better outcomes than excision. Early intervention improves results and reduces neurological sequelae in children.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases in Children
Context:
- Brain abscesses in children are serious infections requiring prompt management.
- Commonly associated with congenital heart disease and ENT infections.
- Treatment has evolved with advanced monitoring and imaging.
Purpose:
- To evaluate the efficacy of a standardized treatment protocol for pediatric brain abscesses.
- To compare outcomes between abscess puncture and excision.
- To analyze mortality rates and neurological sequelae.
Summary:
- A 16-year study treated 33 children with brain abscesses using puncture, antibiotics, and anti-edematous drugs.
- Intracranial pressure monitoring and CT scans guided treatment adjustments.
- Mortality was 6%, with slight neurological sequelae; puncture showed improved results over excision.
Impact:
- Highlights the effectiveness of minimally invasive abscess puncture over surgical excision.
- Demonstrates the importance of integrated treatment protocols including monitoring and imaging.
- Provides evidence for improved outcomes in pediatric neurosurgery for brain abscesses.
Abstract:
In the last 16 years, 33 children have been treated for brain abscesses. Fifteen (45.5%) presented with cyanogenic congenital heart disease; eleven (33.5%) with E.N.T. infection. The standardized treatment protocol included puncture of the abscess, antibiotherapy and anti-edematous drugs. Postoperative permanent epidural ICP monitoring and, in the last 6 years, repeated CT scans indicated when it was necessary to tap the abscess again or to reinforce the anti-edematous treatment. However, in 3 of these 33 cases, the abscess had to be removed. Postoperative mortality rate was 3%. Overall mortality rate was 6%. Neurological sequelae were slight. Epilepsy occurred in 10%. Mental retardation (16%) was only found in children with cyanogenic congenital heart diseases. Repeated CT scans showed the progressive disappearance, within a few months, of the abscess membranes. This study shows an improvement in the results when brain abscesses in children are punctured rather than excised.