Surgical Treatments for Infantile Purulent Meningitis Complicated by Subdural Effusion.
BACKGROUND
Infantile purulent meningitis (PM) is a commonly severe intracranial infectious disease in infants under age 1 year. In recent years, several diagnostic and treatment methods were reported, but in these cases the neurological complications and sequel were often observed, among which subdural effusion (SE) is the most common complication in PM. Timely diagnosis and early intervention are vital for better outcomes. In this study, the surgical treatments for infantile PM complicated by SE were investigated.


METHODS
Patients who had PM complicated by SE in the Children's Hospital of Hebei Province from June 2000 to June 2012 were retrospectively analyzed and 170 patients were enrolled in the study. Surgical treatment for each patient was adopted according to producing effusion time, leucocyte count, protein content, intracranial pressure, and bacteria culture, coupled with cranial ultrasound examination, CT, and MRI scans.


RESULTS
Nearly, 15 patients were cured using serial taps, with a 50% cure rate. Seventeen out of 30 (56.6%) patients receiving subcutaneous reservoir drainage had better outcome. Nearly 80% of patients (55/69) who underwent minimally invasive trepanation and drainage were positive. Surgical procedure of minimally invasive trepanation and drainage combined with drug douche was effective in 63% of patients (19/30). In addition, 6 patients were cured with subdural-peritoneal shunt. Only 1 patient died, after the recurrence of meningitis, and the remaining 4 patients were cured by craniotomy.


CONCLUSIONS
For infantile PM complicated with SE, treatment needs be chosen according to the specific situation. Surgical procedure of minimally invasive trepanation and drainage is a very effective treatment in curing PM complicated by SE. The treatment was highly effective with the use of drug douche. Subdural-peritoneal shunt and craniotomy were as effective as in refractory cases.
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Xianshu
X
Wang
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Xiaoru
X
Zhang
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Hongbin
H
Cao
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Shiyuan
S
Jing
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Zhiguo
Z
Yang
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Zhenghai
Z
Cheng
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Ye
Y
Liu
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Xin
X
Li
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Feifei
F
Gao
Department of Neurosurgery, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China (mainland).
Yuanqi
Y
Ji
D003399:Craniotomy; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007427:Intracranial Pressure; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D013353:Subdural Effusion / Q000150:complications*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome