Child's Nervous System

, Volume 29, Issue 1, pp 105–117

Infections of the Spinal Subdural Space in Children: A Series of 11 Contemporary Cases and Review of all Published Reports. A Multinational Collaborative Effort

  • Adam L. Sandler
  • Dominic Thompson
  • James T. Goodrich
  • Jasper van Aalst
  • Eliezer Kolatch
  • Mostafa El Khashab
  • Farideh Nejat
  • Erwin Cornips
  • Sandeep Mohindra
  • Rahul Gupta
  • Reza Yassari
  • Lawrence B. DanielsIII
  • Arundhati Biswas
  • Rick Abbott
Original Paper

DOI: 10.1007/s00381-012-1916-4

Cite this article as:
Sandler, A.L., Thompson, D., Goodrich, J.T. et al. Childs Nerv Syst (2013) 29: 105. doi:10.1007/s00381-012-1916-4

Abstract

Introduction

Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports.

Methods

A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up.

Results

Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 %) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected.

Conclusions

The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.

Keywords

Spinal subdural infection Spinal subdural abscess Spinal intradural abscess Children 

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Adam L. Sandler
    • 1
  • Dominic Thompson
    • 2
  • James T. Goodrich
    • 1
  • Jasper van Aalst
    • 5
  • Eliezer Kolatch
    • 1
  • Mostafa El Khashab
    • 3
  • Farideh Nejat
    • 4
  • Erwin Cornips
    • 5
  • Sandeep Mohindra
    • 6
  • Rahul Gupta
    • 7
  • Reza Yassari
    • 1
  • Lawrence B. DanielsIII
    • 1
  • Arundhati Biswas
    • 1
  • Rick Abbott
    • 1
  1. 1.Department of Neurological SurgeryMontefiore Medical Center/Albert Einstein College of MedicineBronxUSA
  2. 2.Department of Paediatric NeurosurgeryGreat Ormond Street Hospital for ChildrenLondonUK
  3. 3.Department of Neurological SurgeryHackensack University Medical CenterHackensackUSA
  4. 4.Department of NeurosurgeryTehran University of Medical SciencesTehranIran
  5. 5.Department of NeurosurgeryMaastricht University Medical CenterMaastrichtThe Netherlands
  6. 6.Department of NeurosurgeryPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  7. 7.Department of NeurosurgeryGovind Ballabh Pant HospitalNew DelhiIndia

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