Management of Pyogenic Brain Abscess in Children: Review of 50 Cases
Journal Title: Nepal Journal of Neuroscience - Year 2013, Vol 10, Issue 2
Abstract
The objective of this study was to review the clinical, radiological, bacteriological and operative characteristics of 50 children with brain abscess treated surgically, and to correlate these data with the final outcome at discharge in order to identify possible prognostic criteria. A total of 70 patients were found to have infections needing surgical interventions in children under 17 years of age over 8-year period. Out of those, 50 had pyogenic brain abscess requiring surgery. Thirty of the patients were male and 20 were female. Commonest age group affected was 10-15 years of age (21 out of 50). The most common condition preceding the abscess formation was ear infection (30 out of 50). The most common clinical features in the order of frequency were headache, fever, vomiting, altered sensorium and a focal neurological deficit. Abscesses were more common on the left side (33 vs. 17). Multiple abscesses were found in 9 patients whereas solitary was detected in 41 cases. Accurate preoperative diagnosis based on CT and/ or MRI was possible in 49 cases. Treatment included burrhole aspiration in 46 patients as initial mode of treatment. Ten of these patients required reaspiration. Two patients subsequently required craniotomy and excision of abscess as they failed to respond to repeated aspiration. Four patients underwent craniotomy and drainage of pus or excision of abscess as the initial mode of treatment. Culture of pus was positive in only 17 patients and Proteus spp. was the commonest organism isolated (7 out of 17). Thirty-day hospital mortality was 8.0 %. There is a high predilection for brain abscess in children with ear infections who are between 10-15 years of age. With the good operative intervention and good perioperative antibiotics, mortality has been reduced to 8.0 %.
Authors and Affiliations
Mohan Raj Sharma, MS Associate Professor of Surgery (Neurosurgery)
Keywords
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