title: Neurosurgical management of extraaxial central nervous system infections in children.
abstract: OBJECTIVE
  Extraaxial infections of the CNS, including subdural empyema and epidural abscess, are rare but potentially life-threatening conditions. Symptoms are usually progressive, and early diagnosis is therefore important. Early intervention with appropriate treatment offers the best opportunity for eradicating the infection and promoting maximal neurological recovery.
  
  
  METHODS
  The medical records of children with extraaxial CNS infection over the last 24 years at the Hospital for Sick Children were analyzed. Only those patients with radiological and/or operative confirmation of the diagnosis of subdural empyema or epidural abscess were included in the study. Demographic and clinical data were collected to determine the outcomes after such infections and factors that predict for such outcomes.
  
  
  RESULTS
  The authors identified 70 children who fulfilled the inclusion criteria. Sinusitis was the most common etiology and was seen in 38 patients. All of these patients were older than 7 years of age at diagnosis. Subdural empyemas were diagnosed in 13 patients following bacterial meningitis, and they were found primarily in infants within the 1st year of life. Other etiological factors included otogenic infection (4 cases), postneurosurgical infection (7 cases), and hematogenous spread of infection (7 cases including 6 cases of spinal epidural abscess). Streptococcus anginosus and Staphylococcus aureus were the most common pathogens identified. Sixty-four patients (91.4%) underwent at least 1 neurosurgical procedure. Seizures and cerebral edema from cortical vein thrombosis were the most common complications.
  
  
  CONCLUSIONS
  Due to variable etiology, identification of the responsible microorganism through neurosurgical drainage followed by long-term intravenous antibiotics remains the mainstay in treating extraaxial CNS infections. Optimal outcome is achieved with early diagnosis and therapy.
authors.affiliation: Division of Neurosurgery, The Hospital for Sick Children, The University of Toronto, Ontario, Canada.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Shobhan
authors.initials: S
authors.lastname: Vachhrajani
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: Michael D
authors.initials: MD
authors.lastname: Taylor
authors.forename: Peter
authors.initials: P
authors.lastname: Dirks
authors.forename: James M
authors.initials: JM
authors.lastname: Drake
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003399:Craniotomy; D018450:Disease Progression; D004322:Drainage; D013354:Empyema, Subdural / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D020802:Epidural Abscess / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D009460:Neurologic Examination; D009864:Ontario; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D034366:Streptococcus anginosus; D013296:Streptococcus pneumoniae; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014207:Trephining
chemical_list: D000900:Anti-Bacterial Agents