Madhugiri Venkatesh S, Sastri B V Savitr, Bhagavatula Indira Devi, Sampath Somanna, Chandramouli B A, Pandey Paritosh
Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences, Hosur Road, Bangalore, India.
Childs Nerv Syst. 2011 Jan;27(1):137-44. doi: 10.1007/s00381-010-1169-z. Epub 2010 May 23.
The aims of this study were to analyze the clinical features, radiologic findings, bacteriologic spectrum, and management protocols and outcomes in posterior fossa subdural empyemas in children.
This study is a retrospective analysis of all children (age, <18 years) treated over a ten-year period (1994-2004) at NIMHANS, India. Clinical, bacteriologic, radiologic, and follow-up data were analyzed.
Twenty-seven children with posterior fossa empyemas were treated during this period, making this the largest series to date dealing with this rare entity. Posterior fossa empyemas are seen more commonly in the summer months and in males. Of the patients, 74.1% were in altered sensorium. The clinical features included the triad of fever, headache, and vomiting, which is a nonspecific picture. Cerebellar signs were elicited only in 40%. The most common source was untreated middle ear infection. Pus usually accumulates over the cerebellar convexity and is associated with hydrocephalus in 74% of patients. Cultures of the empyema pus were positive in 74% of cases, and 18.5% had polymicrobial infections. Only 21% of the patients needed a permanent CSF diversion procedure. Craniectomy is the treatment of choice in these cases.
The clinical features are nonspecific. Early surgery can salvage most patients and obviate the need for permanent CSF diversion procedures. Surgery (evacuation of empyema and mastoidectomy), antibiotics, and management of hydrocephalus are the mainstays of treatment.
本研究旨在分析儿童后颅窝硬膜下积脓的临床特征、影像学表现、细菌谱、治疗方案及治疗结果。
本研究是对印度国家精神卫生和神经科学研究所（NIMHANS）在10年期间（1994 - 2004年）治疗的所有18岁以下儿童进行的回顾性分析。对临床、细菌学、影像学及随访数据进行了分析。
在此期间共治疗了27例后颅窝积脓患儿，这是迄今为止关于这一罕见病症的最大病例系列。后颅窝积脓在夏季和男性中更为常见。患者中74.1%存在意识改变。临床特征包括发热、头痛和呕吐三联征，这是一种非特异性表现。仅40%的患者引出小脑体征。最常见的病因是未经治疗的中耳感染。脓液通常积聚在小脑凸面，74%的患者伴有脑积水。74%的脓腔脓液培养呈阳性，18.5%为混合菌感染。仅21%的患者需要永久性脑脊液分流手术。在这些病例中，颅骨切除术是首选治疗方法。
临床特征不具有特异性。早期手术可挽救大多数患者，避免永久性脑脊液分流手术的需要。手术（清除积脓和乳突切除术）、抗生素及脑积水的处理是主要治疗手段。
