Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK.
Br J Neurosurg. 2023 Feb;37(1):45-48. doi: 10.1080/02688697.2020.1868403. Epub 2021 Jan 11.
Spontaneous central nervous system (CNS) infections in children are rare. Treatment involves surgical intervention and antibiotic therapy. We describe a single centre experience of managing this condition in South Wales.
We performed a retrospective review of surgically managed cases in our unit for patients under 18 years of age between 2008 and 2018. Data were collected regarding aetiology, location, microbiology examination, treatment and outcomes.
Twenty-six patients were identified of which 25 case notes were available. Fifteen were male and 10 were female. Median age was 12 years (age range 0.3-17 years). Seven patients (28%) had a burr-hole aspiration and 18 (72%) underwent craniotomy. A second procedure was performed in 10 (40%) and a third procedure in two (8%). Fourteen (56%) had a brain abscess, 10 (40%) had subdural empyema (one was bilateral) and one (4%) had an extradural empyema. Fifteen (60%) had a raised WCC (>11.5 × 10/L) and 22 (88%) had a CRP of >10 mg/L at presentation. Three (12%) patients had a normal WCC and CRP at presentation. Overall, 12 (48%) were secondary to sinus infection, with the most common organism being Streptococcus. Seven (28%) were due to otitis media or mastoiditis, six (24%) had no cause identified. The mean number of CT/MRI scans was 6.7 (range 3-13). The mean follow-up period was 16.7 months (range 1-117 months). At last follow up, 19 (76%) had a GOS of 5, five (20%) had a GOS of 4 and one (12%) had GOS of 3. There were no deaths.
In Wales, outcomes have improved over time in keeping with other paediatric neurosurgical units in England. Increased availability of imaging resources in our hospital and use of neuro-navigation for all cases in our unit as well as earlier identification of sepsis, communication with microbiologists with dedicated ward rounds and, enhanced identification of causative organisms and contemporary anti-microbials have also contributed towards the improved management of this condition.
儿童自发性中枢神经系统（CNS）感染较为罕见。治疗包括手术干预和抗生素治疗。我们描述了威尔士一家中心对此类病症的治疗经验。
我们对 2008 年至 2018 年间我院收治的 18 岁以下患者进行了回顾性研究。收集了病因、部位、微生物学检查、治疗和转归的数据。
共发现 26 例患者，其中 25 例病例资料完整。男性 15 例，女性 10 例。中位年龄 12 岁（年龄范围 0.3-17 岁）。7 例患者（28%）接受了颅骨钻孔抽吸术，18 例（72%）接受了开颅术。10 例（40%）患者进行了第二次手术，2 例（8%）进行了第三次手术。14 例（56%）有脑脓肿，10 例（40%）有硬膜下积脓（1 例为双侧），1 例（4%）有硬脑膜外积脓。15 例（60%）白细胞计数升高（>11.5×10/L），22 例（88%）C 反应蛋白升高（>10mg/L）。3 例（12%）患者的白细胞计数和 C 反应蛋白正常。总体而言，12 例（48%）继发于鼻窦感染，最常见的病原体是链球菌。7 例（28%）由中耳炎或乳突炎引起，6 例（24%）无明确病因。CT/MRI 扫描的平均次数为 6.7 次（范围 3-13 次）。平均随访时间为 16.7 个月（范围 1-117 个月）。末次随访时，19 例（76%）格拉斯哥预后评分（GOS）为 5 分，5 例（20%）为 4 分，1 例（12%）为 3 分。无死亡病例。
在威尔士，随着时间的推移，我们医院的成像资源更加丰富，在我院所有病例中都使用了神经导航，并且更早地识别了脓毒症，与微生物学家进行了专门的查房，增强了对病原体的识别和使用了现代抗菌药物，这都有助于改善对该疾病的管理。
