Management of Pediatric Brain Abscess: Experience with 21 Cases
Keywords:
Brain abscess,, Burhole aspiration, Capsulotomy,, Craniotomy.Abstract
Objective: To evaluate clinical presentation, diagnosis and treatment of brain abscess in pediatric age group.
Material and Methods: This observational study was conducted at the department of Neurosurgery / pathology, Post-graduate medical institute, Lady Reading Hospital Peshawar from Jan 2011 to December 2013. A total of 21 consecutive patients who undergone surgery (aspiration / excision) for brain abscess with age less than 14 years were included in the study irrespective of their gender. Those treated conservatively or age more than 14 years were excluded from the study.
Results: We had total 21 children who underwent surgery for brain abscess in the study period. There were 62% males and 38% females. Most of the patients presented with fever (66.7%) and headache / vomiting (61.9%). Otitis media (33.3%) and cyanotic heart disease (23.8%) were the common predisposing factors. CT brain with contrast was done in all the patients with brain abscess. Most of the children (52.4%) with brain abscess were offered bur-hole aspiration. In 57.1% patients the culture report was positive. The commonly identified orga-nisms were streptococci in 41.7 % cases and staphalococci in 25%.
Conclusions: We concluded from this study that otitis media and cyanotic heart disease were the common pre-disposing factors for pediatric brain abscess. The common presenting features were fever followed by headache / vomiting. CT brain with contrast is the investigation of choice to diagnose brain abscess. Most of the children with brain abscess needs aspiration. Culture was positive in most but not all the cases.
References
2. Miranda HA, Castellar – Leones SM, Elzain MA, Mos-cote – Salazar LR. Brain abscess: Current management. J Neurosci Rural Pract. Aug 2013; 4 (Suppl 1): S67–S81.
3. Britt RH, wilkin’s RH, Rengachary S. Brain abscess in neurosurgery. New york: MeGraw-hill, 1985: 1928-56.
4. Milles ES, Dias PS, Uttley D. CT scanning in the man-agement of intracranial abscesses; a review of 100 cases. Br J Neurosurgey 1988; 2 (4): 439-46.
5. Rousseaus M, lesions F, Destee A et al. Developments in the treatment and prognosis of multiple cerebral abs-cess. Neurosurgey, 1985; 16: 304-8.
6. Kartimenos G, Crockard HA. Multiple brain abscess: a review of fourteen cases. Br J Neurosurgey, 1991; 5 (2): 153-61.
7. Osenbach RK, Loftus CM. Diagnosis and management of brain abscess. Neurosurgery Clin N Am, 1992; 3 (92): 403-20.
8. Canale D J: Willium Maceween and the treatment of brain abscess: revisited after one hundred years. J Neu-rosurg, 1996; 84: 133-42.
9. Sarmast AH, Showkat HI, Bhat AR, Kirmani AR, Ka-chroo MY, Mir SF, et al. Analysis and management of brain abscess; a ten year hospital based study. Turk Neurosurg. 2012; 22 (6): 682-9.
10. Lehri SA, Tareen S, Bazai RM, Khan A, Lehri IA. Cli-nical presentation and surgical management of brain abscess. Pak J of Neurol Surg. 2010; 14 (2); 118-21.
11. Rehman HU, Wahid FI, Ali M, Khan N, Mehmood K, Javaid M. Surgical outcome of otogenic brain abscess in chronic suppurative otitis media. Pak J of neurol Surg. 2010: 14 (1): 79-84.
12. Lee CG, Kang SH, Kim YJ, Shin HJ, Choi HS, Lee JH, et al. Brain abscess in Korean children: A 15 – year sin-gle center study. Korean J Pediatr. 2010 May; 53 (5): 648-52. 13. Haider A, Khatak A. management of brain abscess: stu-dy of 45 cases. Pak J of Neurol Surg. 2008; 12 (1): 6-9.
14. Raha A, Ganjoo P, Singh A, Tandon MS, Singh D. Sur-gery for brain abscess in children with cyanotic heart disease: An anesthetic challenge. J Pediatr Neurosci. 2012 Jan; 7 (1): 23-6.
15. Bharath R V, Premlal KV, Baldia M, Samson SKG. Brain abscess: Trouble by tip of a top in a child. J Pedi-atr Neurosci. 2011; 6 (1): 96–97.
16. Domingo Z, Peter JC, de Villiers JC. Low velocity penetrating craniocerebral injury in childhood. Pediatr Neurosurg. 1994; 21: 45–9.
17. Hiraishi T, Tomikawa M, Kobayashi T, Kawaquchi T. Delayed brain abscess after penetrating transorbital injury. No Shinkei Geka. 2007; 35: 481–6.
18. Abdulaziz A, Aldakhail. Chronic supporative otitis media with intracranial complications. Neurosciences 2006; 4: 322-25.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
