Cerebellar abscesses in children: excision or aspiration?

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Cerebellar abscesses are common neurosurgical emergencies in developing countries, and have a distressingly high mortality rate of 10 to 15% even today. There is still no consensus on the standard approach to these lesions, and controversy persists over whether these lesions should be treated with primary excision or aspiration.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors retrospectively analyzed 82 cases of cerebellar pyogenic abscesses in children treated at their institution over a period of 10 years. This represents the largest such series being described in literature. All lesions except 1 were otogenic in origin. The clinical and radiological features are discussed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Primary excision was undertaken in 66 patients (80%) and aspiration in 16 patients (20%). Five patients in whom the abscesses were initially treated with aspiration subsequently underwent elective excision. Nine (12.6%) of 71 patients in whom the abscesses were excised had residual abscesses on postoperative imaging; in those who had undergone aspiration as the primary treatment, 6 (54.5%) of 11 patients had recurrent abscesses. There were no deaths among the patients who underwent excision of the abscess. Also, excision of posterior fossa abscesses required fewer repeated procedures with lower recurrence rates, and statistically lower rate of complications.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Compared to primary aspiration, the authors found that primary excision is the preferred method for treating cerebellar abscesses.</jats:p></jats:sec>

Focal Intradural Brain Infections in Children: An Analysis of Management and Outcome

“…The management and prognosis depend on the location, pathology and the preoperative status of the patients. We have previously published our data regarding some focal intracranial infections in children (including subdural empyema, infratentorial subdural empyemas and infratentorial abscesses) [1,2,3]. In this report, we describe a comprehensive analysis of factors affecting recurrence and outcome of all the focal intracranial infections in children.…”

Culture-negative Brain Abscess with <i>Streptococcus intermedius</i> Infection with Diagnosis Established by Direct Nucleotide Sequence Analysis of the 16S Ribosomal RNA Gene

“…Microbiological diagnosis can be performed by the aspiration or excision of specimens. In the early cerebritis stage, however, because abscess walls are poorly formed and friable, excision would pose greater risks of injuries to the surrounding cortex than aspiration (20). Aspiration can be carried out at any stage of abscess evolution even when excision is inappropriate in the cerebritis stage (21).…”

Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses

“…In very general terms, we can say that the advantages of stereotactic aspiration are as follows: the simplicity of the operation, the possibility of using the technique during cerebritis 39,41 (GRADE score 1 and 2, respectively), the small degree of trauma involved, and the possibility of not resorting to narcosis. The principle disadvantages are however the frequent need for multiple operations 6,39,46 (GRADE score 1 for each) and the possibility of failure requiring rectification with excision, which has a higher degree of complete success 4,19,39,49 (GRADE score 1 for each).…”

“…Padney et al, 39 to investigate whether cerebral abscesses are better managed by excision or aspiration, evaluated the management of cerebral abscesses in 82 children over a period of 10 years (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). Primary excision was performed in 66 patients (60%) and aspiration in 16 patients (40%).…”