Spennato Pietro, Aliberti Ferdinando, Colaleo Francesco, Mirone Giuseppe, Di Martino Giuliana, Cinalli Giuseppe
Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore n.6, 80129, Naples, Italy.
Department of Neurosciences and Odontostomatological and Reproductive Sciences, Neurosurgical Clinic, Federico II University Naples, Naples, Italy.
Childs Nerv Syst. 2018 Aug;34(8):1579-1582. doi: 10.1007/s00381-018-3861-3. Epub 2018 Jun 9.
Intracerebral abscess is a rare, but very serious complication of neonatal sepsis. Aggressive medical and surgical strategy is warranted in patients with large abscesses.
A neonate with bilateral large frontal abscesses, caused by Serratia marcescens, was operated using a neuroendoscope coupled with an ultrasonic aspiration device. To our knowledge, this is the first report of such utilization of this new tool. The left abscess was surgically drained through endoscopic aspiration using ultrasonic aspirator. Clinical condition rapidly improved, and postoperative MRI of the brain revealed an almost complete resolution of the left abscess. A second endoscopic procedure was performed 1 week later, and the right abscess was endoscopically drained with the same technique. The remaining clinical course was uneventful.
Ultrasonic aspiration is effective in obtaining complete removal of the purulent material and of the dense fibrin layer adherent to the capsule. However, further studies are warranted to determine its real effectiveness, compared with the classic technique. In our opinion, it should be considered an option in more difficult cases, such as abscesses caused by aggressive germs in young or immunocompromised patients, or in case of recurrent lesions, in order to avoid craniotomy and open surgery.
脑内脓肿是新生儿败血症一种罕见但非常严重的并发症。对于有大脓肿的患者，积极的内科和外科治疗策略是必要的。
一名由粘质沙雷氏菌引起双侧额叶大脓肿的新生儿，采用神经内镜联合超声吸引装置进行手术。据我们所知，这是首次报道使用这种新工具的情况。通过超声吸引器经内镜抽吸对左侧脓肿进行手术引流。临床状况迅速改善，术后脑部MRI显示左侧脓肿几乎完全消退。1周后进行了第二次内镜手术，采用相同技术对右侧脓肿进行内镜引流。其余临床过程顺利。
超声吸引在完全清除脓性物质和附着于包膜的致密纤维蛋白层方面是有效的。然而，与传统技术相比，有必要进行进一步研究以确定其实际有效性。我们认为，在更困难的病例中，如年轻或免疫功能低下患者由侵袭性病菌引起的脓肿，或复发性病变的情况下，应将其视为一种选择，以避免开颅手术和开放手术。
