title: Focal intradural brain infections in children: an analysis of management and outcome.
abstract: BACKGROUND
  Focal intradural infections of the brain include empyema and abscess in the supratentorial and infratentorial spaces. These are amenable to surgical management. Various other issues may complicate the course of management, e.g. hydrocephalus with infratentorial lesions or cortical venous thrombosis with supratentorial lesions. Here, we review the management and identify factors affecting outcome in these patients.
  
  
  METHODS
  This is a retrospective analysis of all children (aged <18 years) treated at the National Institute of Mental Health and Neurosciences, Bangalore, India, between 1988 and 2004. Case records were analyzed to obtain clinical, radiological, bacteriological and follow-up data.
  
  
  RESULTS
  There were 231 children who underwent treatment for focal intradural abscess/empyema at our institute. These included 57 children with cerebral abscess, 65 with supratentorial empyema, 82 with cerebellar abscess and 27 with infratentorial empyema. All patients underwent emergency surgery (which was either burr hole and aspiration of the lesion or craniotomy/craniectomy and excision/evacuation), along with antibiotic therapy, typically 2 weeks of intravenous and 4 weeks of oral therapy. The antibiotic regimen was empiric to begin with and was altered if any sensitivity pattern of the causative organism(s) could be established by culture. Hydrocephalus was managed with external ventricular drainage initially and with ventriculoperitoneal shunt if warranted. Mortality rates were 4.8% for cerebral abscess, 9.6% for cerebellar abscess, 10.8% for supratentorial subdural empyema and 3.7% for posterior fossa subdural empyema. The choice of surgery was found to have a strong bearing on the recurrence rates and outcome in most groups, with aggressive surgery with craniotomy leading to excellent outcomes with a low incidence of residual/recurrent lesions.
  
  
  CONCLUSIONS
  Antibiotic therapy, emergency surgery and management of associated complications are the mainstays of treatment of these lesions. We strongly advocate early, aggressive surgery with antibiotic therapy in children with focal intradural infections.
authors: Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors: Venkatesh S
authors: VS
authors: Madhugiri
authors: B V Savitr
authors: BV
authors: Sastri
authors: Umesh
authors: U
authors: Srikantha
authors: Anirban Deep
authors: AD
authors: Banerjee
authors: Sampath
authors: S
authors: Somanna
authors: B Indira
authors: BI
authors: Devi
authors: B A
authors: BA
authors: Chandramouli
authors: Paritosh
authors: P
authors: Pandey
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D002648:Child; D019468:Disease Management; D013354:Empyema, Subdural / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D005490:Focal Infection / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D006849:Hydrocephalus / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents