经皮引流成功治疗小儿全脊髓硬膜外脓肿
Successful Treatment of Pediatric Holo-Spinal Epidural Abscess With Percutaneous Drainage.
作者信息
Ammar Adam A, Hamad Mousa K, Obeidallah Malik S, Kobets Andrew J, Lee Seon-Kyu, Abbott Ira R
机构信息
Department of Neurological Surgery, Montefiore Medical Center, Moses Campus, Bronx, USA.
Department of Neurointerventional Radiology, Montefiore Medical Center, Moses Campus, Bronx, USA.
出版信息
Cureus. 2022 May 4;14(5):e24735. doi: 10.7759/cureus.24735. eCollection 2022 May.
Spinal epidural abscess (SEA) is a rare and potentially devastating neurologic disease that is commonly treated with neurosurgical decompression and evacuation. We describe the case of an 11-month-old immunocompetent infant who presented with a large multiloculated methicillin-resistant abscess in the left lung apex with likely mediastinal involvement, extending into the epidural space from C7 down to L2 causing cord compression which was successfully treated with percutaneous placement of an epidural drainage catheter and antibiotic therapy. Although there are rare reports of percutaneous drainage of SEAs, to our knowledge, there are no reports of successful use of percutaneous indwelling catheters resulting in the complete resolution of an SEA. Holo-spinal epidural abscess in an infant is an extremely rare disease with limited literature available regarding the best practice for its treatment. Multiple considerations must be taken into account when weighing the different treatment options ranging from surgical decompression to conservative management with antibiotic therapy. We present a unique case of successful treatment with percutaneous epidural drain placement. This provides a reasonable alternative for management in children for whom surgical decompression carries multiple risks for complications both acutely and delayed.
脊柱硬膜外脓肿(SEA)是一种罕见且可能具有毁灭性的神经系统疾病,通常采用神经外科减压和引流进行治疗。我们描述了一名11个月大免疫功能正常的婴儿病例,该婴儿左肺尖出现一个巨大的多房性耐甲氧西林脓肿,可能累及纵隔,脓肿从C7向下延伸至L2进入硬膜外间隙,导致脊髓受压,通过经皮放置硬膜外引流导管和抗生素治疗成功治愈。虽然有关于SEA经皮引流的罕见报道,但据我们所知,尚无经皮留置导管成功用于SEA完全消退的报道。婴儿全脊柱硬膜外脓肿是一种极其罕见的疾病,关于其最佳治疗方法的文献有限。在权衡从手术减压到抗生素保守治疗等不同治疗方案时,必须考虑多个因素。我们展示了一例经皮硬膜外引流成功治疗的独特病例。这为手术减压在急性和延迟期都存在多种并发症风险的儿童提供了一种合理的替代治疗方案。
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