[The treatment of cerebral abscesses in children--the clinical experiences of neurosurgical clinic of PMMH in Lodz].

In our study we made attempt to assess which clinical criteria are essential for choosing optimal treatment for children suffering from cerebral abscesses. We observed the clinical results obtained at our Department from treatment of infections of the central nervous system (CNS) in children and analysed them with respect to applied therapy and clinical conditions. Between 1990 to 2000, 45 children aged 3 days to 15 years (mean 1.34 years, standard deviation 3.23 years) with infections of the CNS were treated at our Department. Within this group, 26 patients were diagnosed with cerebral abscesses, 1 with epidural empyema, 3 with subdural empyema and 15 with pyocephalus. 42 patients were operated. In 3 patients a conservative treatment was introduced at the moment when the abscesses were in the initial stage of organisation; in each case after a complete cycle of antibiotic therapy a regression of lesion was noted. The most frequently performed--in 19 patients--surgical procedure was the radical excision of the abscess by craniotomy. In 2 cases a re-operation was necessary. The highest rate of re-operations was noted in the group of children treated by external drainage; within this group of 18 patients only one 3-month-old girl did not require an additional surgical intervention. Neuroendoscopic techniques were used in 7 patients with compound hydrocephalus. Out of 45 treated children, 3 died from encephalitis, the primary reason being the infection of the ventriculo-peritoneal shunt. All children were assessed according to the Glasgow Outcome Scale and the results were significantly worse in those under 3 years in age. We suggest that in children above 3 years of age with mature abscesses of the central nervous system an operative evacuation of the abscesses by craniotomy should be performed.