SavedAdd your journal

Journals / Batı Karadeniz Tıp Dergisi / 2026 / Cilt: 10 Sayı: 2

Surgically treated pediatric intracranial abscesses and empyemas: Characteristics and outcomes from a single-center experience

Cerrahi tedavi uygulanan pediyatrik intrakraniyal apse ve ampiyemler: Tek merkezli bir deneyimden özellikler ve sonuçlar

Muhammed Erkan Emrahoğlu(Ankara Etlik City Hospital, Department of Neurosurgery, Ankara, Türkiye)0000-0002-0939-3117
Mustafa Kavcar(Ankara Etlik City Hospital, Department of Neurosurgery, Ankara, Türkiye)0009-0002-1074-732X
Defne Şahinoğlu Berker(Hatay Education and Research Hospital, Department of Neurosurgery, Hatay, Türkiye)0000-0001-6135-3801
Erdal Reşit Yılmaz(Ankara Etlik City Hospital, Department of Neurosurgery, Ankara, Türkiye)0000-0002-4220-9772
Şükriye Yılmaz(Ankara Etlik City Hospital, Department of Pediatric Radiology, Ankara, Türkiye)0000-0002-5777-6147
Ayşe Kaman(Ankara Etlik City Hospital, Department of Pediatric Infectious Diseases, Ankara, Türkiye)0000-0002-6188-6816
Erhan Türkoğlu(Hacettepe University School of Medicine, Department of Neurosurgery, Ankara, Türkiye)0000-0001-7044-617X
Pages
230–241
Publication Date
2026-08-31
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Neurological status at presentation is the strongest determinant of functional outcome, whereas isolated radiological mass-effect findings have limited prognostic value.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Aim: Pediatric intracranial abscesses and empyemas are neurosurgical emergencies associated with significant morbidity and mortality.
📊
Key Findings & Data:This study evaluated the clinical, radiological, and microbiological characteristics of surgically treated pediatric intracranial suppurative infections, as well as surgical management strategies, functional outcomes, and prognostic factors.
💡
Conclusion & Impact:Neurological status at presentation is the strongest determinant of functional outcome, whereas isolated radiological mass-effect findings have limited prognostic value.
🔬Design:Review & Systematic Survey
📍Scope:2022 Verileri
⚙️Variables:Beyin apsesi · subdural ampiyem · epidural apse

Abstract

Aim: Pediatric intracranial abscesses and empyemas are neurosurgical emergencies associated with significant morbidity and mortality. This study evaluated the clinical, radiological, and microbiological characteristics of surgically treated pediatric intracranial suppurative infections, as well as surgical management strategies, functional outcomes, and prognostic factors. Material and Methods: Twenty-one pediatric patients who underwent surgery for intracranial abscess or empyema between November 2022 and 2025 were retrospectively reviewed. Demographic, clinical, radiological, laboratory, microbiological, and treatment-related data were analysed. Outcomes were assessed using the Glasgow Outcome Scale (GOS) at 6 months and classified as favourable (GOS 5) or unfavourable (GOS ≤ 4). Neurological sequelae were evaluated separately. Non-parametric statistical methods were applied. Results: Subdural empyema was the most common diagnosis (66.7%), and most lesions were supratentorial (95.2%). The median age was 87 months, and 71.4% of patients were male. Craniotomy with drainage was performed in 95.2% of cases. Post-treatment C-reactive protein and white blood cell levels significantly decreased (p<0.001). At 6-month follow-up, 66.7% of patients achieved favourable functional outcomes. A Glasgow Coma Scale score <15 at presentation was strongly associated with unfavourable outcomes (100% vs. 6.7%; p<0.001). No significant association was found between outcomes and midline shift, cerebral edema, infection extent, seizure presence, or etiology. Neurological sequela occurred in 23.8% of patients, and no mortality or recurrence was observed. Conclusion: Successful outcomes can be achieved in pediatric intracranial suppurative infections with appropriate surgical drainage and antibiotic therapy. Neurological status at presentation is the strongest determinant of functional outcome, whereas isolated radiological mass-effect findings have limited prognostic value.

Özet

Amaç: Pediatrik intrakraniyal abse ve ampiyemler, mortalite/morbidite riski taşıyan nöroşirürjik acillerdendir. Bu çalışmada, cerrahi olarak tedavi edilen pediatrik intrakraniyal süpüratif enfeksiyon olgularının klinik, radyolojik ve mikrobiyolojik özellikleri ile cerrahi yönetim stratejileri ve fonksiyonel sonlanımları değerlendirilmiş; prognozu belirleyen faktörler analiz edilmiştir. Gereç ve Yöntemler: Kasım 2022–2025 arasında intrakraniyal abse veya ampiyem nedeniyle cerrahi uygulanan 21 pediatrik hasta retrospektif incelendi. Demografik, klinik, radyolojik, laboratuvar, mikrobiyolojik ve tedaviye ait veriler analiz edildi. Sonlanım 6. aydaki Glasgow Sonuç Ölçeği (GOS) ile değerlendirildi ve iyi (GOS 5) ve kötü (GOS ≤ 4) olarak ikili sınıflandırıldı. Nörolojik sekel ayrı bir sonlanım ölçütü olarak ele alındı. İstatistiksel analizlerde parametrik olmayan yöntemler kullanıldı. Bulgular: En sık tanı subdural ampiyemdi (%66,7) ve büyük çoğunluğu supratentoryaldi (%95,2). Medyan yaş 87 aydı, hastaların %71,4’ü erkekti. Olguların %95,2’sine kraniyotomi ile drenaj uygulandı. Tedavi sonrası C-reaktif protein ve beyaz küre değerlerinde anlamlı düşüş saptandı (her ikisi için p<0,001). Altı aylık takipte %66,7’sinde iyi fonksiyonel sonlanım görüldü. Başvuru anında GKS <15 olması kötü sonlanım ile güçlü şekilde ilişkiliydi (%100 vs. %6,7; p<0,001). Buna karşın orta hat şifti (p=0,638), beyin ödemi (p=1,000), enfeksiyon yaygınlığı (p=0,659), nöbet varlığı (p=0,061) ve etiyoloji (p=1,000) ile sonlanım arasında anlamlı ilişki saptanmadı. Nörolojik sekel oranı %23,8 idi. Mortalite ve enfeksiyon nüksü izlenmedi. Sonuç: Pediatrik intrakraniyal enfeksiyonlarda uygun cerrahi ve antibiyoterapi ile başarılı sonuçlar mümkündür. Başvuru sırasındaki nörolojik durum, fonksiyonel sonlanımın en önemli belirleyicisidir; izole radyolojik kitle etkisi bulgularının ise prognostik değeri sınırlıdır.

🔖

Cite This Article

Emrahoğlu, M. E., Kavcar, M., Berker, D. Ş., Yılmaz, E. R., Yılmaz, Ş., Kaman, A., Türkoğlu, E. (2026). Surgically treated pediatric intracranial abscesses and empyemas: Characteristics and outcomes from a single-center experience. Batı Karadeniz Tıp Dergisi, Cilt: 10 Sayı: 2, 230–241. https://doi.org/10.29058/mjwbs.1881557

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (56)

  1. Yogev R. Focal suppurative infections of the central nervous system. Principles and Practice of Pediatric Infectious Disease: Third Edition: Elsevier; 2009;324-35.
  2. Ramamurthi B, Pande A. Surgery of pyogenic infections. Textbooks of Operative Neurosurgery. 2005(2):303.
  3. Landriel F, Ajler P, Hem S, Bendersky D, Goldschmidt E, Garategui L, et al. Supratentorial and infratentorial brain abscesses: surgical treatment, complications and outcomes--a 10-year single-center study. Acta Neurochir (Wien). 2012;154(5):903-911. https://doi.org/10.1007/s00701-012-1299-z
  4. Gilard V, Beccaria K, Hartley JC, Blanot S, Marqué S, Bourgeois M, et al. Brain abscess in children, a two-centre audit: outcomes and controversies. Arch Dis Child. 2020;105(3):288-291. https://doi.org/10.1136/archdischild-2018-316730
  5. Gelabert-González M, Serramito-García R, García-Allut A, Cutrín-Prieto J. Management of brain abscess in children. J Paediatr Child Health. 2008;44(12):731-735. https://doi.org/10.1111/j.1440-1754.2008.01415.x
  6. Garin A, Thierry B, Leboulanger N, Blauwblomme T, Grevent D, Blanot S, et al. Pediatric sinogenic epidural and subdural empyema: The role of endoscopic sinus surgery. Int J Pediatr Otorhinolaryngol. 2015;79(10):1752-1760. https://doi.org/10.1016/j.ijporl.2015.08.007
  7. Brouwer MC, Coutinho JM, van de Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology. 2014;82(9):806-813. https://doi.org/10.1212/wnl.0000000000000172
  8. Shachor-Meyouhas Y, Bar-Joseph G, Guilburd JN, Lorber A, Hadash A, Kassis I. Brain abscess in children - epidemiology, predisposing factors and management in the modern medicine era. Acta Paediatr. 2010;99(8):1163-1167. https://doi.org/10.1111/j.1651-2227.2010.01780.x
  9. Sáez-Llorens XJ, Umaña MA, Odio CM, McCracken GH, Jr., Nelson JD. Brain abscess in infants and children. Pediatr Infect Dis J. 1989;8(7):449-458. https://doi.org/10.1097/00006454-198907000-00009
  10. Auvichayapat N, Auvichayapat P, Aungwarawong S. Brain abscess in infants and children: a retrospective study of 107 patients in northeast Thailand. J Med Assoc Thai. 2007;90(8):1601-1607. PubMed PMID: 17926990.
  11. Sharma R, Mohandas K, Cooke RP. Intracranial abscesses: changes in epidemiology and management over five decades in Merseyside. Infection. 2009;37(1):39-43. https://doi.org/10.1007/s15010-008-7359-x
  12. Yogev R, Bar-Meir M. Management of brain abscesses in children. Pediatr Infect Dis J. 2004;23(2):157-159. https://doi.org/10.1097/01.inf.0000110272.67271.a2.
  13. Hendaus MA. Subdural empyema in children. Glob J Health Sci. 2013;5 (6):54-59. https://doi.org/10.5539/gjhs.v5n6p54
  14. Sheehan JP, Jane JA, Ray DK, Goodkin HP. Brain abscess in children. Neurosurg Focus. 2008;24(6):E6. https://doi.org/10.3171/foc/2008/24/6/e6
  15. De Bonis P, Anile C, Pompucci A, Labonia M, Lucantoni C, Mangiola A. Cranial and spinal subdural empyema. Br J Neurosurg. 2009;23(3):335-340. https://doi.org/10.1080/02688690902939902
  16. Gezercan Y, Çavuş G, Ökten Aİ, Kuran G, Bilgin E, Açık V, et al. Childhood brain abscess: a single center experience. Cukurova Medical Journal. 2017;42 (3):427-435. https://doi.org/10.17826/cutf.296415
  17. Greenberg MS, Arredondo N. Handbook of Neurosurgery: Thieme New York; 2001.
  18. Corsini Campioli C, Castillo Almeida NE, O’Horo JC, Esquer Garrigos Z, Wilson WR, Cano E, et al. Bacterial brain abscess: an outline for diagnosis and management. Am J Med. 2021;134 (10):1210-1217.e2. https://doi.org/10.1016/j.amjmed.2021.05.027
  19. Ustabaş Kahraman F, Türel Ö, Dündar TT, Seyithanoğlu MH. Brain abscess in children. Pediatric Practice and Research. 2017;5 (1):1-5. https://doi.org/10.21765/pprjournal.412307
  20. McCrory D, Iosif G, Trimble K. Paediatric sinogenic subdural and extradural empyema: a review of local surgical management over 10 years. Ulster Med J. 2025;94(2):83-88. PMID: 41019017; PubMed Central PMCID: PMC12476120.
  21. Ozsürekci Y, Kara A, Cengiz AB, Celik M, Ozkaya-Parlakay A, Karadağ-Oncel E, et al. Brain abscess in childhood: a 28-year experience. Turk J Pediatr. 2012;54(2):144-149. PMID: 22734300.
  22. Muzumdar D, Biyani N, Deopujari C. Subdural empyema in children. Childs Nerv Syst. 2018;34 (10):1881-1887. https://doi.org/10.1007/s00381-018-3907-6
  23. Mameli C, Genoni T, Madia C, Doneda C, Penagini F, Zuccotti G. Brain abscess in pediatric age: a review. Childs Nerv Syst. 2019;35(7):1117-1128. https://doi.org/10.1007/s00381-019-04182-4
  24. Lundy P, Kaufman C, Garcia D, Partington MD, Grabb PA. Intracranial subdural empyemas and epidural abscesses in children. J Neurosurg Pediatr. 2019;24(1):14-21. https://doi.org/10.3171/2019.1.PEDS18434.
  25. Jim KK, Brouwer MC, van der Ende A, van de Beek D. Subdural empyema in bacterial meningitis. Neurology. 2012;79 (21):2133-2139. https://doi.org/10.1212/WNL.0b013e3182752d0e
  26. Adame N, Hedlund G, Byington CL. Sinogenic intracranial empyema in children. Pediatrics. 2005;116(3):e461-467. https://doi.org/10.1542/peds.2004-2501
  27. Arlotti M, Grossi P, Pea F, Tomei G, Vullo V, De Rosa FG, et al. Consensus document on controversial issues for the treatment of infections of the central nervous system: bacterial brain abscesses. Int J Infect Dis. 2010;14 Suppl 4:S79-92. https://doi.org/10.1016/j.ijid.2010.05.010
  28. Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children’s Hospital Boston. Pediatrics. 2004;113(6):1765-1770. https://doi.org/10.1542/peds.113.6.1765
  29. Tewari MK, Sharma RR, Shiv VK, Lad SD. Spectrum of intracranial subdural empyemas in a series of 45 patients: current surgical options and outcome. Neurol India. 2004;52(3):346-349. PubMed PMID: 15472424.
  30. Mauser HW, Ravijst RA, Elderson A, van Gijn J, Tulleken CA. Nonsurgical treatment of subdural empyema. Case report. J Neurosurg. 1985;63(1):128-130. https://doi.org/10.3171/jns.1985.63.1.0128
  31. Muzumdar D, Jhawar S, Goel A. Brain abscess: an overview. Int J Surg. 2011;9(2):136-144. https://doi.org/10.1016/j.ijsu.2010.11.005
  32. Madhugiri VS, Sastri BV, Bhagavatula ID, Sampath S, Chandramouli BA, Pandey P. Posterior fossa subdural empyema in children--management and outcome. Childs Nerv Syst. 2011;27 (1):137-144. https://doi.org/10.1007/s00381-010-1169-z
  33. Mat Nayan SA, Mohd Haspani MS, Abd Latiff AZ, Abdullah JM, Abdullah S. Two surgical methods used in 90 patients with intracranial subdural empyema. J Clin Neurosci. 2009;16 (12):1567-1571. https://doi.org/10.1016/j.jocn.2009.01.036
  34. Legrand M, Roujeau T, Meyer P, Carli P, Orliaguet G, Blanot S. Paediatric intracranial empyema: differences according to age. Eur J Pediatr. 2009;168(10):1235-1241. https://doi.org/10.1007/s00431-008-0918-4
  35. Quraishi H, Zevallos JP. Subdural empyema as a complication of sinusitis in the pediatric population. Int J Pediatr Otorhinolaryngol. 2006;70(9):1581-1586. https://doi.org/10.1016/j.ijporl.2006.04.007
  36. Seydoux C, Francioli P. Bacterial brain abscesses: factors influencing mortality and sequelae. Clin Infect Dis. 1992;15(3):394-401. https://doi.org/10.1093/clind/15.3.394
  37. Patel NA, Garber D, Hu S, Kamat A. Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol. 2016;86:200-212. https://doi.org/10.1016/j.ijporl.2016.05.009
  38. Tekkök IH, Erbengi A. Management of brain abscess in children: review of 130 cases over a period of 21 years. Childs Nerv Syst. 1992;8(7):411-416. https://doi.org/10.1007/bf00304791
  39. Wong TT, Lee LS, Wang HS, Shen EY, Jaw WC, Chiang CH, et al. Brain abscesses in children--a cooperative study of 83 cases. Childs Nerv Syst. 1989;5(1):19-24. https://doi.org/10.1007/bf00706741
  40. Brouwer MC, van de Beek D. Epidemiology, diagnosis, and treatment of brain abscesses. Curr Opin Infect Dis. 2017;30(1):129-134. https://doi.org/10.1097/qco.0000000000000334
  41. Gupta S, Vachhrajani S, Kulkarni AV, Taylor MD, Dirks P, Drake JM, et al. Neurosurgical management of extraaxial central nervous system infections in children. J Neurosurg Pediatr. 2011;7 (5):441-451. https://doi.org/10.3171/2011.2.Peds09500
  42. Lefebvre L, Metellus P, Dufour H, Bruder N. Linezolid for treatment of subdural empyema due to Streptococcus: case reports. Surg Neurol. 2009;71(1):89-91. https://doi.org/10.1016/j.surneu.2007.06.083
  43. Waseem M, Khan S, Bomann S. Subdural empyema complicating sinusitis. J Emerg Med. 2008;35(3):277-281. https://doi.org/10.1016/j.jemermed.2007.07.019
  44. Canpolat M, Ceylan O, Per H, Koc G, Tumturk A, Kumandas S, et al. Brain abscesses in children: results of 24 children from a reference center in Central Anatolia, Turkey. J Child Neurol. 2015;30(4):458-467. https://doi.org/10.1177/0883073814549247
  45. Agrawal A, Timothy J, Pandit L, Shetty L, Shetty JP. A review of subdural empyema and its management. Infectious Diseases in Clinical Practice. 2007;15(3):149-153.
  46. Benevides GN, Salgado GA Jr, Ferreira CR, Felipe-Silva A, Gilio AE. Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome. Autops Case Rep. 2015;5(4):19-26. https://doi.org/10.4322/acr.2015.029
  47. Taha MM, Hassanaın S. Subtentorial subdural empyema: report of two cases and review of the literatures. Turk Neurosurg. 2011;21(4):669-673. PubMed PMID: 22194137.
  48. Sáez-Llorens X. Brain abscess in children. Semin Pediatr Infect Dis. 2003;14(2):108-114. https://doi.org/10.1053/spid.2003.127227
  49. Bodilsen J, D’Alessandris QG, Humphreys H, Iro MA, Klein M, Last K, et al. European society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66-89. https://doi.org/10.1016/j.cmi.2023.08.016
  50. Suthar R, Sankhyan N. Bacterial Infections of the Central Nervous System. Indian J Pediatr. 2019;86(1):60-69. https://doi.org/10.1007/s12098-017-2477-z
  51. Takeshita M, Kagawa M, Yato S, Izawa M, Onda H, Takakura K, et al. Current treatment of brain abscess in patients with congenital cyanotic heart disease. Neurosurgery. 1997;41(6):1270-1278; discussion 8-9. https://doi.org/10.1097/00006123-199712000-00006
  52. Yilmaz N, Kiymaz N, Yilmaz C, Bay A, Yuca SA, Mumcu C, et al. Surgical treatment outcome of subdural empyema: A clinical study. Pediatr Neurosurg. 2006;42(5):293-298. https://doi.org/10.1159/000094065
  53. Osman Farah J, Kandasamy J, May P, Buxton N, Mallucci C. Subdural empyema secondary to sinus infection in children. Childs Nerv Syst. 2009;25(2):199-205. https://doi.org/10.1007/s00381-008-0665-x
  54. Bonfield CM, Sharma J, Dobson S. Pediatric intracranial abscesses. J Infect. 2015;71 Suppl 1:S42-46. https://doi.org/10.1016/j.jinf.2015.04.012
  55. Germiller JA, Monin DL, Sparano AM, Tom LW. Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol Head Neck Surg. 2006;132 (9):969-976. https://doi.org/10.1001/archotol.132.9.969
  56. Patel AP, Masterson L, Deutsch CJ, Scoffings DJ, Fish BM. Management and outcomes in children with sinogenic intracranial abscesses. Int J Pediatr Otorhinolaryngol. 2015;79(6):868-873. https://doi.org/10.1016/j.ijporl.2015.03.020