Neurosurgical management of brain abscesses in children

The authors review the management of brain abscesses (BAbs) in 59 pediatric cases. The major surgical procedure used to treat them was repeated punctu re and aspiration (51 cases, or 86.44%), excision (8 cases - 13.56%) being of secondary importance. The main etiology was metastatic lesions (24 cases - 40.68%), those due to cyanotic congenital heart disease being the most f requent. Single lesions dominated (41 cases - 69.49%). Gram-positive cocci were the main bacteria involved (31 cases, 52.5%). CT scan represented the main tool in the diagnosis and follow-up. Puncture and aspiration in BAbs l ed to a significant decrease in mortality (7 cases - 11.86%), and the incid ence of seizures and neurological deficits was also reduced. Mortality was significantly correlated with the following factors: consciousness status, multiple BAbs location and hematogenous dissemination. There were recurrenc es in 11 cases (18.64%), all observed after aspiration procedures. The curr ent concepts for complex management of BAbs, as reflected in recent literat ure data, are reviewed, with particular emphasis on the use of real-time CT or ultrasound-guided operative techniques.