Outcome of management of brain abscess in children.

Ikram Ullah Khan,Muhammad Kashif Chishti,Muhammad Ashraf,Sadia Sadiq,Abdul Latif

doi:10.12669/pjms.36.3.1087

Abstract

Objective:To find out the outcome of management of brain abscess in children.Methods:This is prospective observational study conducted in the Department of Paediatric Neurosurgery at Children’s Hospital and Institute of Child Health, Multan from July 2014 to June 2017. Children up to the age of 14 years suffering from brain abscess were admitted. After taking clinical history, general and systemic physical examination and necessary investigations, abscess was evacuated and abscess wall excised after performing craniotomy. Data was collected on a predesigned performa. Results were analyzed and compared with national and international literature through statistical package for social sciences (SPSS-20).Results:Twenty five patients up to 14 years of age were included. Seventeen (68%) were male and eight (32%) female. Fever and vomiting were present in all 25 (100%) patients. Paranasal sinusitis was predisposing causative factor in 9(36%) followed by otitis media in 7 (28%). Abscess was present in frontal lobe in 9 (36%), temporoparietal region in 8 (32%), posterior fossa in 5 (20%) and multiple abscesses in 3 (12%). Craniotomy was performed, pus evacuated and abscess wall excised in all 25 (100%) patients. Three (12%) patients expired.Conclusion:Incidence of brain abscess can be decreased by treatment of its predisposing causes as sinusitis and otitis media. Small abscess less than 2cm can be treated with antibiotics. Complete evacuation of pus and excision of abscess wall after performing craniotomy along with appropriate antibiotics is gold standard management of brain abscess in children.

Highlights

Brain abscess is defined as focal suppurative process within the brain parenchyma that begins as a localized area of cerebritis and changes into collection of pus surrounded by a well vascularized capsule
Surgical treatment of brain abscess is aspiration of pus or craniotomy and excision of abscess followed by antibiotic therapy.[7]
Surgical intervention was planned in those patients having brain abscess with size more than 2cm, causing mass effects neurological deficit, at aliquant area or with signs of raised intracranial pressure and these patients were included in the study

Summary

Introduction

Brain abscess is defined as focal suppurative process within the brain parenchyma that begins as a localized area of cerebritis and changes into collection of pus surrounded by a well vascularized capsule. Infectious process that affects the CNS may threaten vital neurological functions and even life itself. The prognosis of these patients has improved over the past 25 years in large measure due to technological advances in diagnostic and treatment modalities as new generation of antibiotics, CT and MRI. The common predisposing factors are paranasal sinusitis, otitis media, trauma, brain surgery and. Mode of entry of causative microorganism is contiguous spread from infected paranasal sinuses and otitis media, hematogenous in endocarditis due to cyanotic heart diseases and direct inoculation in brain during trauma and surgery.[2] Fever, headache, vomiting, seizures are common presentations. Neck rigidity and focal neurological deficits may be present.[3] Intraventricular rupture of abscess and brain herniation may be fatal complications.

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Conclusion