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Paediatric intracranial empyema: differences according to age

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Abstract

No recent studies are available which consider the epidemiology and outcome of paediatric intracranial empyema (PICE). We retrospectively studied all PICE cases admitted in our institution from 1993 to 2006. Outcome was assessed using the Glasgow Outcome Scale (GOS) at 24 months. Aetiology, clinical features, therapeutic considerations and risk factors of poor outcome were analysed according to age. Data from 38 patients were studied; 33/38 presented with subdural empyema (SDE) and 5/38 with extradural empyema (EDE); 10/38 were infants <1 year of age with SDE, all related to bacterial meningitis; 28/38 were children, with 23/28 showing SDE and 5/28 EDE. Oto-sinogenic infections were the main causes in children. All infants recovered completely as did children with EDE. However, two out of 23 children with SDE had permanent neurological deficit, already detected on admission, and one out of 23 died. Thirty-three out of 38 were operated; 16 of which underwent multiple surgical procedure because of recurrence. Burr hole was performed in six infants and craniotomy in one, while 21/23 children underwent burr hole or craniotomy. Burr hole was more often associated with recurrence. In children with SDE, factors associated with poor outcome were neurological deficit (p = 0.002) and cerebral herniation on CT scan (p = 0.02) on admission. In this study, we gained further insights into modern epidemiology of PICE by highlighting age-related aetiology, symptoms, treatment strategy, and outcome differences. Meningitis was the main aetiology in the infants and sinusitis was prevalent in children. Finally, early diagnosis by neuro-imaging investigations and timely and appropriate multidisciplinary treatment may offer the best chance of recovery.

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Abbreviations

PICE:

Paediatric intracranial empyema

SDE:

subdural empyema

EDE:

extra dural empyema

CRP:

C reactive protein

WBC:

white blood cell count

CSF:

cerebrospinal fluid

GOS:

Glasgow Outcome Scale

PGCS:

Paediatric Glasgow coma score

References

  1. Adame N, Hedlund G, Byington CL (2005) Sinogenic intracranial empyema in children. Pediatrics 116:e461–e467

    Article  PubMed  Google Scholar 

  2. Clayman GL, Adams GL, Paugh DR et al (1991) Intracranial complications of paranasal sinusitis: a combined institutional review. Laryngoscope 101:234–239

    Article  PubMed  CAS  Google Scholar 

  3. Dawson KG, Emerson JC, Burns JL (1999) Fifteen years of experience with bacterial meningitis. Pediatr Infect Dis J 18:816–822

    Article  PubMed  CAS  Google Scholar 

  4. Ducrocq SC, Meyer PG, Orliaguet GA et al (2006) Epidemiology and early predictive factors of mortality and outcome in children with traumatic severe brain injury: experience of a French paediatric trauma center. Pediatr Crit Care Med 7:461–467

    Article  PubMed  Google Scholar 

  5. Dureux J, Voiriot P, Auque J et al (1988) Bases of antibiotherapy in neuromeningeal infections. Neurochirurgie 34:72–82

    PubMed  CAS  Google Scholar 

  6. Fairbanks DN, Milmoe GJ (1985) The diagnosis and management of sinusitis in children. Complications and sequelae: an otolaryngologist’s perspective. Pediatr Infect Dis 4:S75–S79

    PubMed  CAS  Google Scholar 

  7. Feuerman T, Wackym PA, Gade GF, Dubrow T (1989) Craniotomy improves outcome in subdural empyema. Surg Neurol 32:105–110

    Article  PubMed  CAS  Google Scholar 

  8. Gallagher RM, Gross CW, Phillips CD (1998) Suppurative intracranial complications of sinusitis. Laryngoscope 108:1635–1642

    Article  PubMed  CAS  Google Scholar 

  9. Giannoni C, Sulek M, Friedman EM (1988) Intracranial complications of sinusitis: a paediatric series. Am J Rhinol 12:173–178

    Article  Google Scholar 

  10. Greenlee JE (2003) Subdural empyema. Curr Treat Options Neurol 5:13–22

    Article  PubMed  Google Scholar 

  11. Guillen A, Brell M, Cardona E et al (2001) Pott’s puffy tumour: still not an eradicated entity. Childs Nerv Syst 17:359–362

    Article  PubMed  CAS  Google Scholar 

  12. Jennett B, Teasdale G, Knill-Jones R (1975) Prognosis after severe head injury. Ciba Found Symp 309–324

  13. Kirkham FJ, Newton CR, Whitehouse W (2008) Paediatric coma scales. Dev Med Child Neurol 50:267–274

    Article  PubMed  Google Scholar 

  14. Kombogiorgas D, Seth R, Athwal R et al (2007) Suppurative intracranial complications of sinusitis in adolescence. Single institute experience and review of literature. Br J Neurosurg 21:603–609

    Article  PubMed  CAS  Google Scholar 

  15. Marquardt G, Setzer M, Schick U, Seifert V (2002) Cerebellar hemorrhage after supratentorial craniotomy. Surg Neurol 57:241–251 discussion 251–242

    Article  PubMed  Google Scholar 

  16. Miller ES, Dias PS, Uttley D (1987) Management of subdural empyema: a series of 24 cases. J Neurol Neurosurg Psychiatry 50:1415–1418

    Article  PubMed  CAS  Google Scholar 

  17. Mohindra S, Mukherjee KK, Gupta R et al (2005) Decompressive surgery for acute subdural haematoma leading to contralateral extradural haematoma: a report of two cases and review of literature. Br J Neurosurg 19:490–494

    Article  PubMed  CAS  Google Scholar 

  18. Nathoo N, Nadvi SS, Gouws E, van Dellen JR (2001) Craniotomy improves outcomes for cranial subdural empyemas: computed tomography-era experience with 699 patients. Neurosurgery 49:872–877 discussion 877–878

    Article  PubMed  CAS  Google Scholar 

  19. Nathoo N, Nadvi SS, Van Dellen JR (2000) Traumatic cranial empyemas: a review of 55 patients. Br J Neurosurg 14:326–330

    Article  PubMed  CAS  Google Scholar 

  20. Nathoo N, Nadvi SS, van Dellen JR, Gouws E (1999) Intracranial subdural empyemas in the era of computed tomography: a review of 699 cases. Neurosurgery 44:529–535 discussion 535–526

    Article  PubMed  CAS  Google Scholar 

  21. Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL (2007) Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke 38:2315–2321

    Article  PubMed  Google Scholar 

  22. Schuchat A, Robinson K, Wenger JD et al (1997) Bacterial meningitis in the United States in 1995. Active surveillance team. N Engl J Med 337:970–976

    Article  PubMed  CAS  Google Scholar 

  23. Shotelersuk V, Goyal M, Rauchenstein JN, Konez O (2001) Subdural empyema secondary to odontogenic masticator space abscess: detection by indium-111-labeled white cell scan. Clin Imaging 25:18–22

    Article  PubMed  CAS  Google Scholar 

  24. Simpson D, Reilly P (1982) Paediatric coma scale. Lancet 2:450

    Article  PubMed  CAS  Google Scholar 

  25. Singh B, Van Dellen J, Ramjettan S, Maharaj TJ (1995) Sinogenic intracranial complications. J Laryngol Otol 109:945–950

    PubMed  CAS  Google Scholar 

  26. Stam J (2005) Thrombosis of the cerebral veins and sinuses. N Engl J Med 352:1791–1798

    Article  PubMed  CAS  Google Scholar 

  27. Syrogiannopoulos GA, Nelson JD, McCracken GH Jr (1986) Subdural collections of fluid in acute bacterial meningitis: a review of 136 cases. Pediatr Infect Dis 5:343–352

    Article  PubMed  CAS  Google Scholar 

  28. Vinchon M, Joriot S, Jissendi-Tchofo P, Dhellemmes P (2006) Postmeningitis subdural fluid collection in infants: changing pattern and indications for surgery. J Neurosurg 104:383–387

    PubMed  Google Scholar 

  29. Yilmaz N, Kiymaz N, Yilmaz C et al (2006) Surgical treatment outcome of subdural empyema: a clinical study. Pediatr Neurosurg 42:293–298

    Article  PubMed  Google Scholar 

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Acknowledgement

The authors would like to thank Alex Dyson for reviewing the manuscript.

Conflict of interest statement

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Anesthesiology and Critical Care, Necker—Enfants Malades Hospital, AP-HP, University Paris Descartes, 149 rue de Sèvres, 75015, Paris, France

    Matthieu Legrand, Philippe Meyer, Pierre Carli, Gilles Orliaguet & Stephane Blanot

  2. Department of Paediatric Neurosurgery, Necker—Enfants Malades Hospital, AP-HP, University Paris Descartes, 149 rue de Sèvres, 75015, Paris, France

    Thomas Roujeau

Authors
  1. Matthieu Legrand
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  2. Thomas Roujeau
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  3. Philippe Meyer
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  4. Pierre Carli
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  5. Gilles Orliaguet
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  6. Stephane Blanot
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Correspondence to Matthieu Legrand.

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Legrand, M., Roujeau, T., Meyer, P. et al. Paediatric intracranial empyema: differences according to age. Eur J Pediatr 168, 1235–1241 (2009). https://doi.org/10.1007/s00431-008-0918-4

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  • DOI: https://doi.org/10.1007/s00431-008-0918-4

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